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Sulfamethoxazole-Trimethoprim
Sulfamethoxazole-Trimethoprim, often known by the brand names Bactrim or Septra, is a combination antibiotic used to treat a variety of bacterial infections. It is commonly prescribed for infections of the urinary tract, respiratory tract, gastrointestinal tract, and skin, and is also used for the prevention and treatment of Pneumocystis jirovecii pneumonia (PCP) in immunocompromised individuals. Sulfamethoxazole is a sulfonamide antibiotic, and trimethoprim is a dihydrofolate reductase inhibitor. Together, they work synergistically to inhibit bacterial growth.
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Frequently Asked Questions
How long does it take for Sulfamethoxazole-Trimethoprim to work?
Most patients start to feel better within 48 to 72 hours of starting the medication. However, it’s important to complete the full course even if symptoms improve early.
Can I drink alcohol while taking Sulfamethoxazole-Trimethoprim?
There are no specific alcohol interactions, but it is generally advisable to avoid alcohol while taking antibiotics, as alcohol can worsen certain side effects such as nausea and dizziness.
Can Sulfamethoxazole-Trimethoprim be used to treat viral infections?
No, this medication is an antibiotic and is not effective against viral infections, such as the common cold or the flu.
What should I do if I miss a dose of Sulfamethoxazole-Trimethoprim?
If you miss a dose, take it as soon as you remember. If it is close to the time of your next dose, skip the missed dose and resume your normal schedule. Do not take two doses at once.
Can Sulfamethoxazole-Trimethoprim cause allergic reactions?
Yes, sulfonamides are known to cause allergic reactions, especially in individuals allergic to sulfa drugs. If you experience a rash, swelling, or difficulty breathing, stop the medication and seek immediate medical attention.
Comprehensive Drug Guide
How Does Sulfamethoxazole-Trimethoprim Work?
- Sulfamethoxazole inhibits the enzyme dihydropteroate synthetase, blocking the production of dihydrofolic acid.
- Trimethoprim inhibits dihydrofolate reductase, preventing the conversion of dihydrofolic acid into tetrahydrofolic acid, which is required for the synthesis of nucleic acids and proteins in bacteria. This combination results in a stronger bactericidal effect than either drug alone.
Common Dosages
- SS tablets: 400 mg of sulfamethoxazole and 80 mg of trimethoprim.
- DS tablets: 800 mg of sulfamethoxazole and 160 mg of trimethoprim.
Typical Dosing
- For uncomplicated UTIs: 1 DS tablet or 2 SS tablets every 12 hours for 3 to 5 days.
- For Pneumocystis jirovecii pneumonia (PCP): 15-20 mg/kg/day of trimethoprim and 75-100 mg/kg/day of sulfamethoxazole divided into 3 or 4 doses.
- For Traveler’s diarrhea: 1 DS tablet every 12 hours for 5 days.
Typical Dosing
FDA Approved Indications
- Urinary tract infections (UTIs)
- Acute otitis media (middle ear infection) in children
- Bronchitis
- Traveler’s diarrhea
- Shigellosis (infection caused by Shigella bacteria)
- Pneumocystis jirovecii pneumonia (PCP) prevention and treatment
It is also used off-label for:
- Methicillin-resistant Staphylococcus aureus (MRSA) skin infections
- Prostatitis
- Toxoplasmosis prevention
Off-Label Uses
Pediatric Dosing
Who Shouldn't Take Sulfamethoxazole-Trimethoprim?
- Hypersensitivity to sulfonamides, trimethoprim, or any component of the formulation.
- Severe liver or kidney disease without proper monitoring.
- Megaloblastic anemia due to folate deficiency.
- Pregnancy, especially during the third trimester, and in breastfeeding mothers due to the risk of kernicterus in newborns.
Advice From The Pharmacist
- Take Sulfamethoxazole-Trimethoprim with a full glass of water to reduce the risk of kidney stones and to ensure proper absorption.
- Complete the full course of the medication, even if symptoms improve early, to prevent antibiotic resistance.
- Avoid prolonged sun exposure or tanning beds, as this medication can make your skin more sensitive to sunlight, increasing the risk of sunburn.
Side Effects of Sulfamethoxazole-Trimethoprim
Common Side Effects
- Nausea
- Vomiting
- Loss of appetite
- Skin rash
- Diarrhea
Uncommon/Severe Side Effects
- Stevens-Johnson syndrome or toxic epidermal necrolysis: Severe skin reactions that require immediate medical attention.
- Blood disorders, including anemia, leukopenia, and thrombocytopenia.
- Hyperkalemia: Increased potassium levels, especially in patients with kidney disease or those taking potassium-sparing diuretics.
- Crystalluria: The formation of crystals in the urine, leading to kidney stones or kidney damage.
Risks and Warnings of Sulfamethoxazole-Trimethoprim
- Hypersensitivity Reactions: Sulfonamide antibiotics like Sulfamethoxazole-Trimethoprim are associated with a higher risk of allergic reactions, including severe skin reactions like Stevens-Johnson syndrome. Stop the medication immediately and seek medical attention if signs of a rash, blistering, or peeling skin occur.
- Kidney and Liver Function: Patients with renal or hepatic impairment should use this medication with caution, as it can worsen these conditions.
- Folate Deficiency: Sulfamethoxazole-Trimethoprim can worsen folate deficiency or cause anemia in susceptible individuals, such as those with malnutrition or the elderly.
Interactions with Sulfamethoxazole-Trimethoprim
Common Drug Interactions
- Warfarin: Sulfamethoxazole-Trimethoprim can increase the effects of warfarin, increasing the risk of bleeding. Close monitoring of INR is recommended.
- ACE inhibitors and ARBs: When used with Sulfamethoxazole-Trimethoprim, these medications can increase the risk of hyperkalemia.
- Methotrexate: The combination may increase the risk of hematologic toxicity (bone marrow suppression), so patients should be monitored closely.
Common Food Interactions
Alternatives to Sulfamethoxazole-Trimethoprim
- Nitrofurantoin: Another antibiotic commonly used for urinary tract infections.
- Ciprofloxacin: A broad-spectrum antibiotic used for bacterial infections, including urinary tract and respiratory infections.
- Doxycycline: Often used for treating bacterial infections and as an alternative for patients allergic to sulfonamides.
