Prophylaxis is recommended for patients with AML and solid tumors for the duration of chemotherapy. The American Academy of Pediatrics AAP does not recommend sulfamethoxazole; trimethoprim as a treatment option in patients with type I penicillin allergy due to the low rates of cross sensitivity between penicillin and second and third generation cephalosporins, which are the recommended alternative agents.
Sulfamethoxazole; trimethoprim is also not recommended as second-line therapy for children who have failed amoxicillin therapy due to high rates of pneumococcal resistance. The FDA-approved treatment duration is 14 days. For HIV-infected patients, treat for 7 to 10 days or extend therapy to at least 14 days with bacteremia. Recurrent infection may require treating for up to 6 weeks. Shigella infections that are acquired outside of the U. Treat for 7 to 10 days or extend therapy to at least 14 days with bacteremia.
Guidelines do not include trimethoprim; sulfamethoxazole. The pattern of recurrence suggested that the greatest benefit of prophylaxis came during the first 6 months, which was the most likely time for recurrent infection.
However, the data suggest that prolonged administration resulted in changes in bacterial susceptibility patterns that increased the risk of symptomatic UTI with bacteria resistant to sulfamethoxazole; trimethoprim. Secondary prophylaxis is only recommended for infants and children with more than 2 serious bacterial infections in a 1-year period who are unable to take antiretroviral therapy.
Secondary prophylaxis should be restarted for more than 2 serious bacterial infections in a 1-year period despite antiretroviral therapy. Children younger than 5 years received mg 5 mL of suspension PO daily and those 5 years and older received mg 10 mL suspension PO daily or matching placebo.
It was concluded that children of all ages with clinical features of HIV infection receive SMX-TMP prophylaxis in resource-poor areas, regardless of local resistance to the antibiotic.
Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible.
Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically. Prophylaxis should not be discontinued in infants younger than 1 year of age. Primary prophylaxis should be restarted if CD4 counts fall below these thresholds. Once daily therapy may be associated with an increased risk of relapse; therefore, a gradual transition from acute therapy may be beneficial, utilizing the twice daily dose for 4 to 6 weeks before switching to once daily dosing.
Restart chronic maintenance therapy if the CD4 count drops below these thresholds. Uncertainty exists regarding the dose of co-trimoxazole for this condition. A retrospective review of 19 patients at Duke University who received co-trimoxazole for treatment of documented Nocardia infection revealed that patients received an average of 8.
For postexposure prophylaxis, administer to asymptomatic close contacts within 3 weeks of exposure, especially patients at high risk for pertussis-related complications e. Symptomatic contacts coughing should be treated as if they have pertussis. If there is reduced susceptibility to vancomycin and daptomycin, sulfamethoxazole; trimethoprim may be administered as a single agent or in combination with other antibiotics.
Although the cure rate was significantly higher with vancomycin after roughly 3 weeks of therapy e. Clinical practice guidelines do not recommend SMX-TMP for endocarditis but acknowledge occasional use as salvage therapy. Consider the addition of an aminoglycoside, such as gentamicin, if lesions do not respond within the first few days of therapy or if the patient also has HIV infection. For pregnant and lactating patients, use erythromycin or azithromycin.
At 2-week follow-up, the success rates were Consider adding sulfamethoxazole; trimethoprim to carbapenem therapy in setting of persistent bacteremia. Consider adding sulfamethoxazole; trimethoprim to carbapenem therapy in the setting of persistent bacteremia. Increasing doses of SMX-TMP are given every 15 minutes for 31 doses; then, if protocol tolerated, begin sulfonamide therapy as indicated.
Data on sulfonamide desensitization protocols are lacking in pediatric patients. The desensitization protocol was successful in 4 of the 5 patients.
Another protocol in HIV-infected patients, 4 of whom were pediatric patients, used sulfamethoxazole; trimethoprim suspension administered orally every 8 hours beginning with , of the desired total daily dose and progressing through serial dilutions of ,, ,, , , , and Subsequently, the desired dosage was administered orally twice per day. The desensitization protocol was successful in 6 of the 7 patients. Day 2 0.
Day 3 0. Day 4 0. Day 5 0. Data on ambulatory sulfonamide desensitization protocols are lacking in pediatric patients. The following desensitization regimen was used all doses represent trimethoprim component : Day 1: 0.
Additional oral therapy rifampin plus another MRSA agent, such as sulfamethoxazole; trimethoprim should continue for 3 months for hip infections or for 6 months for knee infections. Additional oral therapy rifampin plus another MRSA agent, such as sulfamethoxazole; trimethoprim should start after the completion of IV therapy and continue for 3 months for hip infections or for 6 months for knee infections. Oral therapy should be continued until spine fusion has occurred.
Long term oral suppressive therapy may be considered in select cases, especially if device removal is not possible. No intraoperative redosing and a duration of prophylaxis less than 24 hours for most procedures are recommended by clinical practice guidelines.
Clinical practice guidelines recommend sulfamethoxazole; trimethoprim for urologic procedures involving lower tract instrumentation with risk factors for infection, including transrectal prostate biopsy. Oral rifampin may be added. Treat for 4 to 6 weeks for brain abscess, subdural empyema, spinal epidural abscess, or septic thrombosis of the cavernous or dural venous sinus.
A longer duration may be necessary with persistent or complicated infections. Treat for a minimum of 2 weeks and for at least 7 days after complete resolution of the infection for exit site infections. Treat for 2 to 4 weeks for tunnel infections. For serious infections or complications i. Give in combination with rifampin or doxycycline pediatric patients older than 8 years to reduce the incidence of relapse. Children with high-risk criteria e.
Discontinuation may be considered in patients without evidence of active infection who have sustained improvement in immunologic status CDC immunologic category 1 or 2 for longer than 6 months in response to ART. Both sulfamethoxazole and trimethoprim are metabolized by the liver.
Dosage adjustments may be necessary in patients with hepatic impairment; however, specific dosage adjustment guidelines are not available. NOTE: The doses below are expressed in terms of the trimethoprim content of the fixed combination, which consists of 5 mg sulfamethoxazole: 1 mg trimethoprim.
May be administered without regard to meals. Administer with food, water, or milk to minimize gastric irritation.
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Rapid or direct IV injection must be avoided. Dilute 5 ml of the concentrate for injection in ml of D5W. For fluid-restricted patients, 75 ml of D5W may be used. Use diluted solution within 2 hours of preparation and do not refrigerate. Infuse over a period of 60—90 minutes. Change infusion site every 48—72 hours. Generic: - Discard product if it contains particulate matter, is cloudy, or discolored - Discard unused portion 48 hours after initial puncture of container - Do not refrigerate - Store at controlled room temperature between 68 and 77 degrees F Bacter-Aid DS : - Store at controlled room temperature between 68 and 77 degrees F Bactrim: - Store at controlled room temperature between 68 and 77 degrees F Bactrim DS: - Store at controlled room temperature between 68 and 77 degrees F Septra: - Store at controlled room temperature between 68 and 77 degrees F Septra DS: - Store at controlled room temperature between 68 and 77 degrees F Sulfatrim: - Protect from light - Store at controlled room temperature between 68 and 77 degrees F Sulfatrim Pediatric: - Protect from light - Store at controlled room temperature between 68 and 77 degrees F Sultrex Pediatric : - Protect from light - Store at controlled room temperature between 68 and 77 degrees F.
Some formulations of injectable sulfamethoxazole; trimethoprim contain propylene glycol as a solvent. When administered in high doses as for the treatment of P. Propylene glycol toxicity may result in hyperosmolarity with anion gap metabolic acidosis, including lactic acidosis. Additionally, propylene glycol toxicity may result in acute kidney injury, CNS toxicity, and multi-organ failure.
Monitor patients for the total daily intake of propylene glycol from all sources and for acid-base disturbances. Discontinue sulfamethoxazole; trimethoprim if propylene glycol toxicity is suspected. Sulfamethoxazole; trimethoprim is contraindicated in patients with either sulfonamide hypersensitivity or trimethoprim hypersensitivity.
Fatalities have been documented in patients with sulfonamide hypersensitivity who receive sulfonamides, usually secondary to Stevens-Johnson syndrome, toxic epidermal necrolysis, or hepatic necrosis. Because of structural similarity, sulfonamides should be used cautiously in patients with known allergic reactions to thiazide diuretics, oral sulfonylureas, or carbonic anhydrase inhibitors.
Despite the chemical similarities between furosemide and sulfonamides and the logical conclusion that cross-sensitivity would occur, a thorough review of the published literature and direct communication with the manufacturer revealed no data supporting the conclusion that patients with sensitivity to sulfonamides also develop sensitivity to furosemide.
Less is known regarding the cross-sensitivity between sulfonamides and the other agents, although some clinicians doubt that significant risk exists. Nevertheless, sulfamethoxazole; trimethoprim should be avoided in patients with furosemide hypersensitivity, thiazide diuretic hypersensitivity, sulfonylurea hypersensitivity, or carbonic anhydrase inhibitor hypersensitivity.
Additionally, sulfamethoxazole; trimethoprim injection contains sodium metabisulfite and should not be used in patients with sulfite hypersensitivity; those at risk are found more frequently amongst asthmatic than non-asthmatic members of the population.
Severe life-threatening anaphylactic reactions or less severe asthmatic episodes can develop in susceptible patients. Sulfamethoxazole; trimethoprim is contraindicated in patients with folate deficiency megaloblastic anemia since either component could exacerbate this condition; be use with caution in patients with mild folate deficiency. Caution is advised when administering the drug to patients with bone marrow suppression, as sulfonamides have been associated with fatalities resulting from agranulocytosis, aplastic anemia, and other blood dyscrasias.
Do not administer to patients with G6PD deficiency; hemolysis and hemolytic anemia may occur if patients with G6PD deficiency receive sulfamethoxazole; trimethoprim; this reaction is frequently dose related.
Discontinue the drug at the first appearance of serious blood disorders. It should be used cautiously in patients with moderate renal impairment i. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in patients with preexisting risk factors e. Monitor serum potassium levels in patients with risk factors for developing drug-induced hyperkalemia renal impairment, elderly, high-dose trimethoprim.
In addition, use trimethoprim with caution in patients receiving drugs known to significantly increase serum potassium. Sulfamethoxazole; trimethoprim has also been associated with severe cases of hyponatremia, particularly in patients receiving treatment for pneumocystis pneumonia PCP.
Health care providers are advised to monitor for the development of hyponatremia and implement appropriate corrective measures as needed in symptomatic patients. Sulfamethoxazole; trimethoprim is contraindicated in patients with marked hepatic damage or hepatic disease.
Because both sulfonamides and trimethoprim are metabolized in the liver, caution should be used when these drugs are given to patients with any degree of hepatic disease. Metabolism can be decreased, and as a result, toxicity may occur. Patients who are "slow acetylators" may be more prone to idiosyncratic reactions to sulfonamides. Sulfonamides, such as sulfamethoxazole, can cause an acute attack of porphyria, and should not be used in patients with this condition.
Almost all antibacterial agents, including sulfamethoxazole; trimethoprim, have been associated with pseudomembranous colitis or C.
Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. Consider pseudomembranous colitis in patients presenting with diarrhea after antibacterial use. Careful medical history is necessary as pseudomembranous colitis has been reported to occur over 2 months after the administration of antibacterial agents. If pseudomembranous colitis is suspected or confirmed, ongoing antibacterial therapy not directed against C. Institute appropriate fluid and electrolyte management, protein supplementation, C.
As with all medications containing sulfonamides, use sulfamethoxazole; trimethoprim with caution in patients with hypothyroidism. Use caution when administering sulfamethoxazole; trimethoprim to persons with human immunodeficiency virus HIV infection or acquired immunodeficiency syndrome AIDS.
Persons with AIDS may not tolerate or respond to treatment in the same manner as other persons. Persons with AIDS may experience more drug-related side effects, including rash, fever, leukopenia, elevated hepatic enzymes, and hyperkalemia.
Reevaluate sulfamethoxazole; trimethoprim therapy or re-challenge in patients who develop rash, fever, leukopenia, or other treatment-related adverse reactions. If treatment is continued, closely monitor potassium concentrations and ensure adequate fluid intake during therapy.
During a clinical trial, persons with HIV with PCP receiving these drugs in combination experienced treatment failure and excess mortality. Sulfamethoxazole; trimethoprim is contraindicated in neonates and infants less than 2 months old.
Sulfonamides may cause bilirubin displacement and kernicterus in this age group. Additionally, sulfamethoxazole; trimethoprim injection contains benzyl alcohol as a preservative. Normal sulfamethoxazole; trimethoprim doses would deliver benzyl alcohol at amounts lower than those reported with gasping syndrome; however, the minimum amount of benzyl alcohol to cause toxicity is unknown. Consider the combined daily metabolic load of benzyl alcohol from all sources if using sulfamethoxazole; trimethoprim injection in infants.
Sulfamethoxazole; trimethoprim may be used as adjunctive therapy with pyrimethamine in the treatment of congenital toxoplasmosis or for the prophylaxis of PCP in infants 1 month and older. Sulfamethoxazole; trimethoprim may cause fetal harm if administered during pregnancy. Use sulfamethoxazole; trimethoprim during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Limited data have also linked first trimester exposure to sulfamethoxazole; trimethoprim to an increased risk for congenital malformations i. However, other studies such as the Collaborative Perinatal Project, which included 1, mothers with first trimester sulfonamide exposure and 5, with exposure anytime during pregnancy, found no evidence to suggest a relationship between sulfonamide use and fetal malformations.
If sulfamethoxazole; trimethoprim is used during pregnancy, the patient should be advised of the potential risk to the fetus and supplemental multivitamins should be administered.
Because of the potential risk of bilirubin displacement and kernicterus, avoid breast-feeding during treatment with sulfamethoxazole; trimethoprim. However, previous American Academy of Pediatrics AAP recommendations considered sulfamethoxazole; trimethoprim as usually compatible with breast-feeding.
An extensive review in HIV-infected women suggested that the risk of kernicterus in the breast-feeding infant is very low. In a study of 12 newborn infants of less than 3 days postnatal age receiving systemic sulfamethoxazole; trimethoprim, the authors noted that despite therapeutic serum concentrations, there was no displacement of bilirubin from albumin in the newborns. If sulfamethoxazole; trimethoprim is administered to the mother of a young infant, monitor the infant for signs of increased bilirubin and jaundice.
Ciprofloxacin, amoxicillin, and nitrofurantoin cautioned in the infant with glucosephosphate dehydrogenase deficiency may be potential alternatives to consider during breast-feeding as generally considered compatible by previous AAP recommendations. Cases of hypoglycemia have been reported in non-diabetic patients receiving treatment with sulfamethoxazole; trimethoprim. These events are uncommon and usually develop after a few days of therapy. Risk factors include, renal and hepatic dysfunction, malnutrition, and those patients receiving high drug doses.
Photosensitivity can occur with sulfonamide treatment, so patients should avoid or limit sunlight UV exposure, including sunlamps and tanning booths. Sunscreens should be employed, but may provide limited protection for this reaction. Discontinue sulfamethoxazole; trimethoprim use at the first sign of erythema. Cases of QT prolongation resulting in ventricular tachycardia and torsade de pointes have been reported with the use of sulfamethoxazole; trimethoprim.
Use sulfamethoxazole; trimethoprim with caution in patients with conditions that may increase the risk of QT prolongation including congenital long QT syndrome, bradycardia, AV block, heart failure, stress-related cardiomyopathy, myocardial infarction, stroke, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause an electrolyte imbalance. Females, elderly patients, patients with sleep deprivation, pheochromocytoma, sickle cell disease, hypothyroidism, hyperparathyroidism, hypothermia, systemic inflammation e.
Sulfamethoxazole; trimethoprim is renally eliminated and should be used cautiously in geriatric patients, who have an age-related decline in renal function. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in patients with preexisting risk factors, such as geriatric patients. Monitor serum potassium levels in geriatric patients and use sulfamethoxazole; trimethoprim with caution in geriatric patients receiving drugs known to increase serum potassium significantly.
Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, colitis, or vaginitis. Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions.
Laboratory test interference may occur with sulfamethoxazole; trimethoprim. Specifically, trimethoprim may interfere with serum methotrexate assays that are determined by the competitive binding protein technique CBPA when a bacterial dihydrofolate reductase is used as the binding protein.
Methotrexate measurements by a radioimmunoassay are not affected. Fatalities and serious adverse reactions, including serious rash, including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia DRESS , acute generalized exanthematous pustulosis AGEP , and acute febrile neutrophilic dermatosis AFND , have been reported with the use of sulfamethoxazole; trimethoprim.
Use caution and monitor for hematologic toxicity during concurrent use. Moderate Concomitant use of trimethoprim and zidovudine may result in additive hematological abnormalities. Acarbose: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.
Sulfonamides may induce hypoglycemia in some patients by increasing the secretion of insulin from the pancreas. Patients at risk include those with compromised renal function, those fasting for prolonged periods, those that are malnourished, and those receiving high or excessive doses of sulfonamides. Acetaminophen; Aspirin, ASA; Caffeine: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
An enhanced effect of the displaced drug may occur. Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Acetohexamide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Taking these drugs together may also increase risk for phototoxicity. Patients should limit sunlight and UV exposure, and follow proper precautions for sunscreens and protective clothing. Patients at risk for hypoglycemia due to sulfonamides include those with compromised renal function, those fasting for prolonged periods, those that are malnourished, and those receiving high or excessive doses of sulfonamides.
Albiglutide: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. An increased incidence of thrombocytopenia with purpura has been reported in elderly patients during coadministration. Aliskiren; Valsartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Hyperkalemia may be more significant in patients receiving IV trimethoprim.
For those patients at higher risk of hyperkalemia e. Trimethoprim has a potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in those with pre-existing risk factors. Alogliptin; Metformin: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.
Alogliptin; Pioglitazone: Moderate It is possible that an increase in the exposure of pioglitazone may occur when coadministered with other drugs that inhibit CYP2C8 such as trimethoprim. Monitor for changes in glycemic control if trimethoprim is coadministered with pioglitazone. Alpha-glucosidase Inhibitors: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment.
Amantadine: Major Avoid concurrent use of amantadine and trimethoprim. A single case of toxic delirium has been reported after coadministration of trimethoprim and amantadine. Amiloride: Major Trimethoprim has a potassium-sparing effect and may induce hyperkalemia, especially in patients with pre-existing risk factors for hyperkalemia e.
Patients, especially those with renal dysfunction, should be carefully monitored for hyperkalemia during concomitant use of potassium-sparing diuretics and trimethoprim. Major Trimethoprim has a potassium-sparing effect and may induce hyperkalemia, especially in patients with pre-existing risk factors for hyperkalemia e. Aminosalicylate sodium, Aminosalicylic acid: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Amitriptyline: Moderate Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly. The efficacy of tricyclic antidepressants can decrease when administered with sulfamethoxazole; trimethoprim. Amitriptyline; Chlordiazepoxide: Moderate Monitor therapeutic response and adjust the tricyclic antidepressant dose, if needed, when use sulfamethoxazole; trimethoprim concomitantly.
Amlodipine; Benazepril: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary. Hyperkalemia may be more signficant in patients receiving IV trimethoprim. Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Amlodipine; Olmesartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary.
Amlodipine; Telmisartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary.
Amlodipine; Valsartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Amoxicillin: Minor Sulfonamides may compete with amoxicillin for renal tubular secretion, increasing amoxicillin serum concentrations. Use this combination with caution, and monitor patients for increased side effects. Amoxicillin; Clarithromycin; Lansoprazole: Minor Sulfonamides may compete with amoxicillin for renal tubular secretion, increasing amoxicillin serum concentrations.
Amoxicillin; Clarithromycin; Omeprazole: Minor Sulfonamides may compete with amoxicillin for renal tubular secretion, increasing amoxicillin serum concentrations. Amoxicillin; Clavulanic Acid: Minor Sulfonamides may compete with amoxicillin for renal tubular secretion, increasing amoxicillin serum concentrations.
Ampicillin: Minor Sulfonamides may compete with ampicillin for renal tubular secretion, increasing ampicillin serum concentrations. Ampicillin; Sulbactam: Minor Sulfonamides may compete with ampicillin for renal tubular secretion, increasing ampicillin serum concentrations.
Angiotensin II receptor antagonists: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary. Angiotensin-converting enzyme inhibitors: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary. Aprepitant, Fosaprepitant: Minor Use caution if sulfamethoxazole and aprepitant are used concurrently and monitor for a possible decrease in the efficacy of sulfamethoxazole.
After administration, fosaprepitant is rapidly converted to aprepitant and shares the same drug interactions. The effects of aprepitant on tolbutamide were not considered significant. Articaine; Epinephrine: Moderate Coadministration of articaine with oxidizing agents, such as sulfonamides, may increase the risk of developing methemoglobinemia.
Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. If methemoglobinemia occurs or is suspected, discontinue articaine and any other oxidizing agents.
Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen. Aspirin, ASA: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Aspirin, ASA; Butalbital; Caffeine: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Aspirin, ASA; Butalbital; Caffeine; Codeine: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Aspirin, ASA; Caffeine: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Aspirin, ASA; Caffeine; Dihydrocodeine: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Aspirin, ASA; Caffeine; Orphenadrine: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Aspirin, ASA; Carisoprodol: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Aspirin, ASA; Carisoprodol; Codeine: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Aspirin, ASA; Dipyridamole: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Aspirin, ASA; Omeprazole: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Aspirin, ASA; Oxycodone: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Aspirin, ASA; Pravastatin: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Atenolol; Chlorthalidone: Major Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. No difference was observed in atovaquone pharmacokinetics. This may not be of any clinical significance but should be used with caution. Because methenamine salts produce an acidic urine, these agents should not be used concomitantly. Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides.
Azathioprine: Moderate Azathioprine may interact with other drugs that are myelosuppressive. Drugs that may affect the production of leukocytes, including sulfamethoxazole; trimethoprim, SMX-TMP, may lead to exaggerated leukopenia, especially in patients who have received a renal transplant. Azilsartan: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin II receptor antagonist and trimethoprim is necessary.
Azilsartan; Chlorthalidone: Major Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Benazepril: Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary. Moderate Monitor for hyperkalemia if concomitant use of an angiotensin-converting enzyme ACE inhibitors and trimethoprim is necessary.
Bendroflumethiazide; Nadolol: Major Avoid the concomitant use of sulfamethoxazole; trimethoprim and thiazide diuretics. Benzalkonium Chloride; Benzocaine: Moderate Rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine products. Examples of other drugs that can cause methemoglobinemia include the sulfonamides. Therefore, caution is warranted when combining such medications with topical or oromucosal benzocaine products.
Patients using OTC benzocaine gels and liquids should be advised to seek immediate medical attention if signs or symptoms of methemoglobinemia develop. In addition, clinicians should closely monitor patients for the development of methemoglobinemia when benzocaine sprays are used during a procedure. Benzocaine: Moderate Rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine products.
Benzocaine; Butamben; Tetracaine: Moderate Rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine products. Bismuth Subcitrate Potassium; Metronidazole; Tetracycline: Major Medications with significant alcohol content should not be ingested during therapy with metronidazole and should be avoided for 3 days after therapy is discontinued.
Bismuth Subsalicylate: Minor Due to high protein binding, salicylates could be displaced from binding sites, or could displace other highly protein-bound drugs such as sulfonamides. Bismuth Subsalicylate; Metronidazole; Tetracycline: Major Medications with significant alcohol content should not be ingested during therapy with metronidazole and should be avoided for 3 days after therapy is discontinued.
Boceprevir: Moderate Close clinical monitoring is advised when administering sulfamethoxazole with boceprevir due to an increased potential for sulfamethoxazole-related adverse events. If sulfamethoxazole dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Nursing mothers. See Contraindications. May potentiate oral anticoagulants eg, warfarin , hypoglycemics, phenytoin, methotrexate, digoxin; monitor.
May be potentiated by indomethacin. May increase risk of thrombocytopenia with diuretics esp. Nephrotoxicity with cyclosporine in renal transplant. May antagonize tricyclic antidepressants. May interfere with assays for serum methotrexate, creatinine. PJP treatment: avoid leucovorin. Nausea, vomiting, anorexia, allergic skin reactions, blood dyscrasias eg, megaloblastic anemia , hemolysis, hepatic or renal toxicity, crystalluria, pancreatitis, photosensitivity, drug fever, rash may be serious, eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, others , hypoglycemia, hyperkalemia, hyponatremia; C.
Drugs » Infectious Diseases Bacterial infections Bacterial infections: Indications for: BACTRIM Susceptible infections including UTIs not for initial uncomplicated episodes , shigellosis, prophylaxis and treatment of Pneumocystis jiroveci pneumonia PJP , travelers' diarrhea or acute exacerbations of chronic bronchitis in adults, acute otitis media in children.
J Fam Pract. A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. J Antimicrob Chemother. Comparison of once-daily extended-release ciprofloxacin and conventional twice-daily ciprofloxacin for the treatment of uncomplicated urinary tract infection in women. Clin Ther. Susceptibility of antimicrobial-resistant urinary Escherichia coli isolates to fluoroquinolones and nitrofurantoin.
Clin Infect Dis. Multidrug-resistant urinary tract isolates of Escherichia coli : prevalence and patient demographics in the United States in Antimicrob Agents Chemother. National prevalence of Escherichia coli resistance to trimethoprim-sulfamethoxazole: managed care implications in the treatment of urinary tract infections.
J Manag Care Pharm ; Naber KG. Treatment options for acute uncomplicated cystitis in adults. Short-course ciprofloxacin treatment of acute uncomplicated urinary tract infection in women. The minimum effective dose [published correction appears in Arch Intern Med ;]. Arch Intern Med. Single-dose fluoroquinolone therapy of acute uncomplicated urinary tract infection in women: results from a randomized, double-blind, multicenter trial comparing single-dose to 3-day fluoroquinolone regimens.
Stein GE. Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection. Fosfomycin for urinary tract infections. Med Lett Drugs Ther. Cranberries for treating urinary tract infections.
Cochrane Database Syst Rev. Efficacy and safety of ciprofloxacin oral suspension versus trimethoprim-sulfamethoxazole oral suspension for treatment of older women with acute urinary tract infection. J Am Geriatr Soc. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Lutters M, Vogt N. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Coordinator of the series is John Tipton, M.
Get Permissions. Read the Issue. Sign Up Now. Aug 1, Issue. C 24 Fluoroquinolones are not recommended as first-line treatment of uncomplicated UTIs in order to preserve their effectiveness for complicated UTIs.
C 24 Use of betalactam antibiotics is not recommended for the routine treatment of uncomplicated UTIs because of limited effectiveness. C 24 For treatment of uncomplicated urinary tract infections in older women, consider short or longer three to 10 days courses of antibiotics. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription.
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