Co-trimoxazole
Class: Sulfonamides
- Antiprotozoal Agents
VA Class: AM900
CAS Number: 8064-90-2
Brands: Bactrim, Bactrim DS, Septra, Septra DS, Sulfatrim
Introduction
Antibacterial; fixed combination of sulfamethoxazole (intermediate-acting sulfonamide) and trimethoprim; both sulfamethoxazole and trimethoprim are folate-antagonist anti-infectives.
Uses for Co-trimoxazole
Acute Otitis Media
Treatment of acute otitis media (AOM) in adults† and children caused by susceptible Streptococcus pneumoniae or Haemophilus influenzae when the clinician makes the judgment that the drug offers some advantage over use of a single anti-infective.
Not a drug of first choice; considered an alternative for treatment of AOM, especially for those with type I penicillin hypersensitivity. Because amoxicillin-resistant S. pneumoniae frequently are resistant to co-trimoxazole, the drug may not be effective in patients with AOM who fail to respond to amoxicillin.
Data are limited regarding safety of repeated use of co-trimoxazole in pediatric patients <2 years of age; the drug should not be administered prophylactically or for prolonged periods for treatment of AOM in any age group.
GI Infections
Treatment of travelers’ diarrhea caused by susceptible enterotoxigenic Escherichia coli. Replacement therapy with oral fluids and electrolytes may be sufficient for mild to moderate disease; those who develop diarrhea with ≥3 loose stools in an 8-hour period (especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in the stools) may benefit from short-term anti-infectives. Fluoroquinolones (ciprofloxacin, levofloxacin, norfloxacin, ofloxacin) usually drugs of choice when treatment indicated; co-trimoxazole also has been recommended as an alternative when fluoroquinolones cannot be used (e.g., in children).
Prevention of travelers’ diarrhea† in individuals traveling forrelatively short periods to areas where enterotoxigenic E. coli and other causative bacterial pathogens (e.g., Shigella) are known to be susceptible to the drug. CDC and others do not recommend anti-infective prophylaxis in most individuals traveling to areas of risk; the principal preventive measures are prudent dietary practices. If prophylaxis is used (e.g., in immunocompromised individuals such as those with HIV infection), a fluoroquinolone (ciprofloxacin, levofloxacin, ofloxacin, norfloxacin) is preferred. Resistance to co-trimoxazole is common in many tropical areas.
Treatment of enteritis caused by susceptible Shigella flexneri or S. sonnei when anti-infectives are indicated.
Treatment of dysentery caused by enteroinvasive E. coli† (EIEC). AAP suggests that an oral anti-infective (e.g., co-trimoxazole, azithromycin, ciprofloxacin) can be used if the causative organism is susceptible.
Treatment of diarrhea caused by enterotoxigenic E. coli† (ETEC) in travelers to re..
