Trimethoprim combinations

Buniva G, Palminteri R, Berti M. Kinetics of a rifampicin-trimethoprim combination. Int J Chn Pharmacol... 

Guillebaud J. Sulpha-trimethoprim combinations and male infertility. Lancet 1978 2(8088) 523. 

AIDS." A primary infection that is treated with the combination is PCP. The sulfonamide-trimethoprim combination can be used fur treatment and prophylaxis. Additionally, cerebral toxoplasmosis con be treated in active infection or prophyluctically. Urinary tract infections and bum therapy" " " round out the list of therapeutic applications. The sulfonamides arc drugs of choice for a few other types of infections, but their u.sc is quite limited in modem antimicrobial chemotherapy." " "... 

A variety of serious toxicity and hypersensitivity problems have been reported with sulfonamide and sulfonamide-trimethoprim combinations. Mandell and Pem "" note that these problems occur in about of all patients. Hypersensi-... 

Urinary Tract Infections. The sulfa drugs have maintained an important place in treatment of urinary tract infections, where short acting, highly soluble drugs are requited (19). Those most used in the United States ate sulfts ox azole, sulfamethizole, sulfisomidine, and sulfacytine. For chronic urinary tract infection, the sulfamethoxazole—trimethoprim combination is ftequendy employed. 

As on date, there exist a few typical sulphonamides and partieularly the sulphonamide-trimethoprim combinations which find their applications exclusively and most extensively for the management and treatment of the opportunistic infections in humans having AIDS. A few typical examples are as illustrated below ... 

Co-lrimoxazcde (trimethoprim combined with suUamethoxazule). Because the side-effecLs of co-trimoxazole are mainly the same us those of the sulphonamides, its use is now largely restricted to treating patients w ith PneunuKystis carinii (meumonia. nocardiasis and t[Pg.81]

The sulfa dmgs are stiH important as antimicrobials, although they have been replaced in many systemic infections by the natural and semisynthetic antibiotics. They are of great value in third world countries where problems of storage and lack of medical personnel make appropriate use of antibiotics difficult. They are especially useful in urinary tract infections, particularly the combination of sulfamethoxazole with trimethoprim. Their effectiveness has been enhanced by co-adniinistration with dihydrofolate reductase inhibitors, and the combination of sulfamethoxazole with trimethoprim is of value in treatment of a number of specific microbial infections. The introduction of this combination (cotrimoxazole) in the late 1960s (1973 in the United States) resulted in increased use of sulfonamides. 

Sulfonamides in combination with dihydrofolate reductase inhibitors are of continuing value. Pyrimethamine [58-14-0] (5) in combination with sulfonamides is employed for toxoplasmosis (7), and a trimethoprim (6)-sulfamethoxa2ole preparation is used not only for urinary tract infections but also for bmceUosis, cholera, and malaria. 

Table 3. Representative Minimum Inhibitory Concentrations for Urinary Tract Organisms by Sulfamethoxazole (SMX), Trimethoprim (TMP), and Their Combination...

Other Infections. The slowly excreted sulfonamides (eg, sulfamethoxypyrida2ine, sulfadimethoxine) are used for treatment of minor infections such as sinusitis or otitis, or for prolonged maintenance therapy. Soluble sulfonamides are sometimes used for proto2oal infections in combination with other agents. Pyrimethamine, combined with sulfonamides, has been used for toxoplasmosis or leishmaniasis, and trimethoprim with sulfonamides has been used in some types of malaria. In nocardiosis, sulfonamides have been used with cycloserine [68-41-7] (17). 

Diaveridine (1044) is a close relative of trimethoprim (Section 2.13.4.2.3) and is made by an analogous Principal Synthesis. It is used prophylactically against coccidiosis in poultry and in combination with sulfaquinoxaline as a curative agent for the same disease similar mixtures are also effective (64MI21305). 

Accessory DHPS enzymes confer resistance to sulfonamides. Two different types encoded by the genes sull (located on transposons) and sulll (located on plasmids) have been described. These resistance determinants are often genetically linked to trimethoprim resistance genes. Therefore, the combination of sulfonamide antibiotics with trimethoprim does not prevent resistance selection. 

Ms. Watson has diabetes and is taking tolbutamide (Orinase). Her primary care provider prescribes the combination drug sulfamethoxazole and trimethoprim (Septra) for a bladder infection. Discuss any instructions information you would give to Ms. Watson in the patient education session... 

Trimethoprim (Trimpex) interferes with the ability of bacteria to metabolize folinic acid, thereby exerting bacteriostatic activity. Trimethoprim is used for UTIs that are caused by susceptible microorganisms. Trimethoprim administration may result in rash, pruritus, epigastric distress, nausea, and vomiting. When trimethoprim is combined with sulfamethoxazole (Septra), the adverse effects associated with a sulfonamide may also occur. The adverse reactions seen with other anti-infectives, such as ampicillin, the sulfonamides, and cephalosporins, are given in their appropriate chapters. 

In patients with normal gallbladder function, effective agents for eradication of chronic carriage include amoxicillin (3 g divided three times a day in adults for 3 months), trimethoprim-sulfamethoxazole (one double-strength tablet twice a day for 3 months), and ciprofloxacin (750 mg twice daily for 4 weeks). In patients with anatomic abnormalities, such as biliary or kidney stones, surgery combined with antibiotic therapy is indicated. 

Trimethoprim Trimethoprim Inhibits folic acid synthesis by Used in combination with... 

The answers are 484-k 485-j. (tlardman, pp 1061-1062, 1682-1685.) Sulfonamides can cause acute hemolytic anemia. In some patients it mayr be related to a sensitization phenomenon, and in other patients the hemolysis is due to a glucose-6-phosphate dehydrogenase deficiency Sulfamethoxazole alone or in combination with trimethoprim is used to treat UTls. The sulfonamide sulfasalazine is employed in the treatment of ulcerative colitis. Daps one, a drug that is used in the treatment of leprosy, and primaquine, an anti mala rial agent, can produce hemolysis, particularly in patients with a glucose-6-phosphate dehydrogenase deficiency. 

A combination therapy with doxycydine, aminoglycosides, trimethoprim-sulfamethoxazole, or fluoroquinolones... 

Drugs of choice are not yet identified. Y. enterocolitica is generally susceptible to fluoroquinolones, alone or in combination with third-generation cephalosporins or aminoglycosides. Alternative agents include chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole. 

Patients with noninfected bite injuries should be given prophylactic antibiotic therapy for 3 to 5 days. Amoxicillin-clavulanic acid (500 mg every 8 hours) is commonly recommended. Alternatives for penicillin-allergic patients include fluoroquinolones or trimethoprim-sulfamethoxazole in combination with clindamycin or metronidazole. First-generation cephalosporins, macrolides, clindamycin alone, or aminoglycosides are not recommended, as the sensitivity to E. corrodens is variable. 

Noli, C., Koeman, J.P., andWillemse, T., A retrospective evaluation of adverse reactions to trimethoprim-sulphonamide combinations in dogs and cats. Vet. Q., 17, 123-128, 1995. 

Tetracycline 500 mg every six hours or doxycycline 100 mg every twelve hours for five to seven days will shorten the duration of illness, and fever usually disappears within one to two days after treatment is begun. Ciprofloxacin and other quinolones are active in vitro and should be considered for victims unable to take tetracycline or doxycycline. Successful treatment of Q fever endocarditis is much more difficult. Tetracycline or doxycycline given in combination with trimethoprim-sulfamethoxazole (TMP-SMX) or rifampin for twelve months or longer has been successful in some cases. However, valve replacement is often required to achieve a cure. 

Treatment — Various antibiotics are useful in treating Coxiella infections. They include tetracycline, doxycycline, and erythromycin. In cases of endocarditis, treatments with doxycycline combined with rifampin, and trimethoprim-sulfamethoxazole combined with doxycycline or tetracycline for 12 months or longer have been successful.3... 

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