Sulphamethoxazole + Trimethoprim
Cotrimoxazole having broad spectrum bactericidal activity against a wide range of gram-positive & gram-negative bacteria and some protozoa. Co-trimoxazole containing Trimethoprim and Sulphamethoxazole in a 1:5 combination exerts its bactericidal action by the sequential blockade of two bacterial enzyme systems in the biosynthesis of folinic acid in the microorganism.
Cotrimoxazole double strength tablet: Over 12 yearsFor mild to moderate infections: 1 tablet twice daily.For severe infections: 1.5 tablets twice daily.Long term therapy (>14 days): 0.5 tablet twice daily.Gonorrhoea: 2 tablets every 12 hours for two days or 2.5 tablets followed by a further dose of 2.5 tablets after 8 hours.Cotrimoxazole tablet: over 12 yearsFor mild to moderate infections: 2 tablets twice daily.For severe infections: 2 tablets thrice daily.Long term therapy: (>14 days): 1 tablet twice daily.Cotrimoxazole suspension: Under 12 years6-12 years: 2 teaspoonful twice daily.6 month-5 years: 1 teaspoonful twice daily.6 weeks-6 months: 0.5 teaspoonful twice daily.
Hypersensitivity to trimethoprim or sulphonamides.Patients with documented megaloblastic anaemia due to folate deficiency.Patients showing marked liver parenchymal damage, blood dyscrasia, severe renal insufficiency, glucose 6-phosphate dehydrogenase deficiency.
The side effects like crystalluria, allergic reactions, haemolysis, thrombocytopenia, neutropenia, agranulocytosis etc. have been reported rarely with Sulphamethoxazole-Trimethoprim combination. Other side effects are less serious in nature such as malaise, headache, nausea and vomiting. These are normally transient and do not require withdrawal of treatment.
Pregnancy and during the nursing period, because sulphonamides pass the placenta and are excreted in the breast milk and may cause kernicterus.
Prolonged full dose treatment with sulfamethoxazole-trimethoprim combination is associated with the risk of macrocytic anaemia due to the drug’s interference in the conversion of Folic acid into Folinic acid. If this occurs, it can be reversed by giving Folinic acid. Care should be taken when giving Cotrim to diabetic patients receiving sulphonylurea drug for possible potentiation of action of sulphonylurea.
Anti-diarrhoeal Antimicrobial drugs, Sulphonamides & Trimethoprim
Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.
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