Cotrimoxazole

Author:Prof. Dr. med. Peter Altmeyer

Last updated on: 12.11.2021

Synonym(s)

Trimethoprim-Sulfamethoxazole

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DefinitionThis section has been translated automatically.

Chemotherapeutic agent; mixture of sulfamethoxazole and trimethoprim.

Half-lifeThis section has been translated automatically.

9–12 h

Pharmacodynamics (Effect)This section has been translated automatically.

Inhibition of tetrahydrofolic acid production and competitive inhibition of dihydrofolate reductase.

Spectrum of actionThis section has been translated automatically.

Acinetobacter spp., Bordetella pertussis, Brucella spp., Citrobacter spp., Enterobacter spp., Enterococcus spp., E. coli, Haemophilus influenzae, Klebsiella spp., Listeria monocytogenes, Morganella morganii, Nocardia spp, Plasmodium falciparum (only in combination), Pneumocystis carinii (in high dosage), Proteus spp., Rochalimaea spp., Salmonella spp., Serratia macescens, Shigella spp., Staphylococcus spp., Streptococcus spp., Vibrio spp., Yersinia spp.

IndicationThis section has been translated automatically.

Respiratory tract infections, Pneumocystis carinii pneumonia, infections of the urinary tract, gastrointestinal tract, female genital tract (not syphilis!), prostatitis. Proph. of Pneumocystis carinii pneumonia in HIV patients.

Limited indicationThis section has been translated automatically.

Pregnancy 2nd and 3rd trimester, impaired renal function, mild hepatic dysfunction, thyroid dysfunction, hypersensitivity to sulfonylureas, diuretics and sulfonamide-based antidiabetics, especially folic acid deficiency, fragile X chromosome in combination with mental retardation in children.

Dosage and method of useThis section has been translated automatically.

Standard therapy: 2 times/day 2 tbl (80 mg TMP + 400 mg SM) p.o.
For Pneumocystis carinii pneumonia:
- Light PCP: double dosage i.v.
- Heavy PCP: SM 1 time 100 mg/kg bw, TMP 20 mg/kg bw, e.g. 3 times 5 amp. in 500 ml NaCl over 90 min. for 21 days.
- Prophylaxis of PCP: 4 Tbl. forte (160 mg TMP + 800 mg SMZ) 3 times/week p.o.

Undesirable effectsThis section has been translated automatically.

Pulmonary infiltrates, pneumonia, BB changes, gastrointestinal disorders, acute pancreatitis, petechiae, allergic reactions, Wissler syndrome, glossitis, gingivitis, headache, ataxia, hypoglycemia, metabolic acidosis, arthralgias. Cotrimoxazole is reported in versch. Cotrimoxazole is mentioned in various studies as the most frequent trigger of Stevens-Johnson syndrome (Micheletti RG et al. 2018).

InteractionsThis section has been translated automatically.

s. Table 1.

ContraindicationThis section has been translated automatically.

Pregnancy 1. Trimenon, lactation (newborns with hyperbilirubinemia or glucose-6-phosphate dehydrogenase deficiency as well as premature infants), hypersensitivity to sulfonamides and trimethoprim analogues, erythema exsudativum multiforme (also in the medical history), severe BB changes, glucose-6-phosphate dehydrogenase deficiency, hemoglobin abnormalities, kidney damage, decompensated renal insufficiency, severe liver damage, liver dysfunction, acute hepatic porphyria.

PreparationsThis section has been translated automatically.

Bactoreduct, Berlocid, Cotrim, Cotrimox-Wolff, Drylin, Eusaprim, Kepinol, Supracombin, TMS

Note(s)This section has been translated automatically.

Occurrence of sweet syndrome after taking cotrimoxazole has been described in the literature.

LiteratureThis section has been translated automatically.

Callen JP et al (2002) Neutrophilic dermatoses. Dermatol Clin 20: 409-419
Micheletti RG et al (2018) Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States. J Invest Dermatol 138:2315-2321.

TablesThis section has been translated automatically.

Major drug interactions of cotrimoxazole

Antacids	Absorption of the sulfonamide moiety ↓
Antidiabetics, oral	Hypoglycemic tendency↑
Anticoagulants, oral	bleeding tendency ↑
Barbiturates	Trimethoprim toxicity ↑
Indometacin	Sulfonamide action ↑
Methotrexate	MTX toxicity ↑
Phenylbutazone	Sulfonamide action ↑
Phenytoin	Phenytoin effect ↑ in individual cases.
Pyrimethamine (> 25 mg/week).	BB changes
Salicylates	Sulfonamide effect ↑
Sulfinpyrazone	Sulfonamide effect ↑

Authors

Last updated on: 12.11.2021

Author: Prof. Dr. med. Peter Altmeyer