Trimethoprim/ sulfamethoxazole

A monograph (1) covers the pioneering period of sulfa dmg development and describes over 5000 sulfanilamide derivatives, their preparation, properties, trade names, and biological testing. This review is remarkably complete through 1944. Several thousand additional derivatives have been made since, but no comparable coverage is available. A definitive account of medical appHcations up to 1960 has been pubHshed (2), and a review of experimental antibacterial aspects has been made (3). Chapters on general aspects of sulfonamides and sulfones have appeared (4,5). A review of the clinical efficacy of trimethoprim—sulfamethoxazole has been pubHshed (6). 

Long-term daily fluoroquinolone or trimethoprim/ sulfamethoxazole... 

Salsalate 750 mg by mouth twice daily Trimethoprim-sulfamethoxazole SS tablets by mouth twice daily for 7 days (last treatment was 1 month ago)... 

Trimethoprim-sulfamethoxazole, amoxicillin, first-generation cephalosporins, and erythromycin are not recommended due to susceptibility and resistance patterns of the likely infectious organisms. 

To prevent development of resistance and promote synergy, inhaled tobramycin or colistin is usually added to an oral fluoroquinolone for P. aeruginosa coverage.1,3 Methicillin-sensitive S. aureus (MSSA) may be treated with oral amoxiciUin-clavulanic acid, dicloxacillin, first- or second-generation cephalosporins, trimethoprim-sulfamethoxazole, or clindamycin, depending on sensitivity. Likewise, methiciUin-resistant S. aureus (MRSA) may be treated with oral trimethoprim-sulfamethoxazole, clindamycin, minocycline, or linezolid. H. influenzae often produces... 

P-lactamases but can usually be treated with amoxidUin-clavulanic acid, a cephalosporin, or trimethoprim-sulfamethoxazole. Oral trimethoprim-sulfamethoxazole or minocycline may be used to treat S. maltophilia. 

Patients who have previously experienced spontaneous bacterial peritonitis and have low-protein ascites (ascitic fluid albumin less than 1 g/dL [less than 10 g/L]) are candidates for long-term prophylactic therapy. Recommended regimens include either a single trimethoprim-sulfamethoxazole doublestrength tablet 5 days per week (Monday through Friday) or ciprofloxacin 750 mg once weekly.19,46 Any patient who has experienced an episode of variceal bleeding should also receive prophylactic antibiotics. 

Sulfa drugs Mild rash occurred 2 hours after taking a double-strength trimethoprim-sulfamethoxazole tablet prescribed for a urinary tract infection. 

ACE-I, angiotensin-converting enzyme inhibitors ARB, angiotensin-receptor blockers AZA, azathioprine CMV, cytomegalovirus CPK, creatinine phos-phokinase CSA, cyclosporine HMG-CoA, 3-hydroxy 3-methylglutaryl coenzyme A reductase K+, potassium LFTs, liver function tests Rl, renal insufficiency SCr, serum creatinine SRL, sirolimus TAC, tacrolimus TMP-SMX, trimethoprim-sulfamethoxazole. 

Streptococcus gentamicin (5 mg/kg per day, dosing based on serum levels) Alternative Therapies Trimethoprim-sulfamethoxazole (TMP-SMX) 10-20 mg/kgTMP IV per day in divided doses every 6-8 hours or meropenem Standard Therapy TMP-SMX Rash, Stevens-Johnson syndrome, bone marrow suppression, nausea/vomiting, hepatotoxicity 14-21... 

Trimethoprim- sulfamethoxazole 8-10 mg/kg per day of trimethoprim component in 2 doses Nausea, vomiting, anorexia, rash, urticaria S Increasing pneumococcal resistance contraindicated in children under 2 months... 

Antibiotic resistance plays a smaller role in pharyngitis therapy compared with other URIs. O Penicillin resistance has not yet been documented in group A streptococci, but resistance and clinical failures occur more frequently with tetracyclines, trimethoprim-sulfamethoxazole, and to a lesser degree macrolides. 

CA-MRSA is susceptible to more antibiotics than HA-MRSA. Like HA-MRSA, CA-MRSA typically is sensitive to vancomycin, linezolid, daptomycin, tigecycline, and quinupristin/ dalfopristin, but it also may be sensitive to clindamycin, doxy-cycline, minocycline, and/or trimethoprim-sulfamethoxazole (TMP-SMX).14... 

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. 

The cornerstone of cholera treatment is fluid replacement. Without treatment, the case-fatality rate for severe cholera is approximately 50%. For cholera, rice-based ORT is better than glucose-based ORT because it reduces the number of stools.21 Patients with significant disease should receive a short antibiotic course, 1 to 3 days, to shorten the duration of illness and decrease the number of stools. Doxycycline 300 mg once daily is the drug of choice. Other antibiotics shown to be effective include erythromycin, azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin.2 Antibiotic resistance has been documented in V cholerae since 1977.2 Antibiotic prophylaxis is not warranted. 

There are no major advantages of these agents over others in the treatment of UTIs, and they are more expensive. They may be useful in cases of resistance to amoxicillin and trimethoprim-sulfamethoxazole. These agents are not active against enterococci. 

Complicated Trimethoprim-sulfamethoxazole Trimethorpim Norfloxacin 1 DS tablet 100 mg 400 mg Twice a day 7-10 days 7-10 days 7-10 days... 

Acute Trimethoprim- sulfamethoxazole 1 DSa tablet Once a day 6 months... 

BUN, blood urea nitrogen CBC, complete blood cell count CNS, central nervous system CYP, cytochrome P-450 isoenzyme LFT, liver function test MAO, monoamine oxidase QTc, Q-T interval corrected for heart rate SCr, serum creatinine TMP-SMX, trimethoprim-sulfamethoxazole. 

Prophylactic trimethoprim-sulfamethoxazole is recommended for all patients receiving alemtuzumab. 

Lee, J., Hollyer, R., Rodelas, R., Preuss, H. G., The influence of trimethoprim, sulfamethoxazole, and creatinine on renal organic anion and cation transport in rat kidney tissue, Toxicol. Appl. Pharmacol. 1981, 58, 184-193. 

Trimethoprim-sulfamethoxazole DS BID for 2 days each week for patients who require any corticosteroids... 

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