Shigellosis trimethoprim-sulfamethoxazole

A combination of trimethoprim-sulfamethoxazole is effective treatment for a wide variety of infections including P jiroveci pneumonia, shigellosis, systemic salmonella infections, urinary tract infections, prostatitis, and some nontuberculous mycobacterial infections. It is active against most Staphylococcus aureus strains, both methicillin-susceptible and methicillin-resistant, and against respiratory tract pathogens such as the pneumococcus, Haemophilus sp, Moraxella catarrhalis, and Klebsiella pneumoniae (but not Mycoplasma pneumoniae). However, the increasing prevalence of strains of E coli (up to 30% or more) and pneumococci that are resistant to trimethoprim-sulfamethoxazole must be considered before using this combination for empirical therapy of upper urinary tract infections or pneumonia. 

Intravenously administered trimethoprim-sulfamethoxazole is indicated in severe cases of Pneumocystis carinii pneumonia. Gram-negative bacterial sepsis, and shigellosis. 

The combination is an alternative to fluoroquinolone for treatment of shigellosis, but resistance to trimethoprim—sulfamethoxazole is increasingly common. 

Septra DS Septra SS Antibiotic Tab Sulfamethoxazole 800 mg, trimethoprim 160 rrg Tab Sulfamethoxazole 400 mg, trimethoprim 80 mg Urinary tract infections 1 tab bid x 7-10 days Shigellosis 1 lab bid x 3-5 days Bronchitis 1 tab bid x 2 weeks Travelers diarrhea 1 tab bid x 5 days Rash common Stevens Johnson Syndrome (erythema multiforme) rarely UTI Prophylaxis 1 tabqhs... 

Septra IV Antibiotic Inj per 5 mL Sulfamethoxazole 400 mg, trimethoprim 80 mg P carinii pneumonia 15 mg/l day (based on TMP) IV in 3 doses x 21 days (each dose in 250 mL of D5Wover 2 hours). Urinary tract infections and shigellosis 8-10 mg/kg daily based on trimethoprim in 3 equal doses (q8h by IV infusion) for 7 days. 

Trimethoprim and sulfamethoxazole (TMP-SMZ) This important drug combination is currently accepted treatment for complicated urinary tract infections and for respiratory, ear, and sinus infections due to H influenzae and Moraxella catarrhalis. In the immunocompromised patient, TMP-SMZ is used for infections due to Aeromonas hydrophila and is the drug of choice for prevention and treatment of pneumocystis pneumonia. TMP-SMZ is a possible backup drug for typhoid fever and shigellosis and has been used in the treatment of infections caused by methicillin-resistant staphylococci and Listeria monocytogenes. 

It Is easier to demonstrate synergy in vitro than in vivo, and concerns about the toxic contribution of the sulfonamide (and, doubtless, commercial considerations as well) have led to a recent vogue for the use of trimethoprim alone. Trimethoprim has a broad spectrum in vitro, so it Is potentially useful against many microorganisms. Combined with sulfamethoxazole, it Is used for oral treatment of urinary tract infections, shigellosis, otitis media, traveler s diarrhea, methicillin-resistant Staphylococcus aureus (MRSA), Legionella infection, and bronchitis. 

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