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trimethoprim/sulfamethoxazole (trye-meth-oh-prim/sul-fa-meth-ox-a-zole)

Apo-Sulfatrim, Apo-Sulfatrim DS, Bactrim, Bactrim DS, Cofatrim, Cotrim, Cotrim DS, Novo-Trimel, Novo-Trimel DS, Nu-Cotrimox, Nu-Cotrimox DS, Roubac, Septra, Septra DS, SMZ/TMP, Sulfatrim, Sulfatrim DS, TMP/SMX, TMP/SMZ


Therapeutic: anti-infectives, antiprotozoals

Pharmacologic: folate antagonists, sulfonamides


Treatment of: Bronchitis, Shigella enteritis, Otitis media, Pneumocystis carinii pneumonia (PCP), Urinary tract infections, Traveler's diarrhea. Prevention of PCP in HIV-positive patients. Unlabeled Use: Biliary tract infections, osteomyelitis, burn and wound infections, chlamydial infections, endocarditis, gonorrhea, intra-abdominal infections, nocardiosis, rheumatic fever prophylaxis, sinusitis, eradication of meningococcal carriers, prophylaxis of urinary tract infections, and an alternative agent in the treatment of chancroid. Prevention of bacterial infections in immuno-suppressed patients.


Combination inhibits the metabolism of folic acid in bacteria at two different points. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Active against many strains of gram-positive aerobic pathogens, including, Streptococcus pneumoniae, Staphylococcus aureus, Group A beta-hemolytic streptococci, Nocardia, Enterococcus. Has activity against many aerobic gram-negative pathogens, such as Acinetobacter, Enterobacter, Klebsiella pneumoniae, Escherichia coli, Proteus mirabilis, Shigella, Haemophilus influenzae, including ampicillin-resistant strains. P. carinii (a protozoa). Not active against Pseudomonas aeruginosa.

Adverse Reactions/Side Effects

CNS: fatigue, hallucinations, headache, insomnia, mental depression. GI: PSEUDOMEMBRANOUS COLITIS, HEPATIC NECROSIS, nausea, vomiting, diarrhea, stomatitis, hepatitis, cholestatic jaundice. GU: crystalluria. Derm: TOXIC EPIDERMAL NECROLYSIS, rashes, photosensitivity. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, hemolytic anemia, leukopenia, megaloblastic anemia, thrombocytopenia. Local: phlebitis at IV site. Misc: ALLERGIC REACTIONS, INCLUDING ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, fever.


Examination and Evaluation

  • Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria, dermatitis, exfoliation). Notify physician immediately, especially about severe skin reactions that might indicate Stevens-Johnson syndrome, toxic epidermal necrosis, or erythema mutiforme.

  • Watch for signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, or other severe or prolonged GI problems (nausea, cramps, vomiting). Report these signs to the physician immediately.

  • Be alert for signs of hepatic necrosis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician immediately.

  • Monitor signs of agranulocytosis (fever, sore throat, mucosal lesions, signs of infection), aplastic anemia (fatigue, shortness of breath with exertion, pale skin), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness, fatigue, infection, or other symptoms that might be due to other blood dyscrasias. Report these signs to the physician immediately.

  • Monitor signs of mental depression, hallucinations, or other changes in mood and behavior. Notify physician if these changes become problematic.

  • Assess IV site during and after IV administration, and report signs of phlebitis and venous thrombosis ...

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