CO-TRIMOXAZOLE

Indications & Dose:

Infections of the urinary tract, otitis media, acute exacerbation of chronic bronchitis, enteritis, Pneumocystis carinii pneumonia (treatment and prophylaxis), traveler’s diarrhea, cholera, salmonella-type infections, nocardiosis, prostatitis

DOSE

Adult: 2 tab or 10ml  every 12 hours Fort/Ds tablets: 1 tablet every 12 hours

Paeds suspension

Children: Under 6 weeks not recommended, 6 weeks-5 months; 2.5ml, 6 month-5 years; 5ml, Over 6 years; 10ml All twice daily

Inj

Adults: Inj i.m: 3-4.5ml twice daily for 3ml thrice daily. Higher dose of max 3 days., Inj i.v: 10ml diluted and infused twice daily. Severe infections: 15ml.

Children: Inj i.m: Over 12 years: 3-4.5ml twice daily or 3ml thrice daily. Higher dose for max. 32 days. 6-12 years: 1.5ml twice daily. Not recommended for children below 6 years., Inj i.v: 10ml diluted and infused twice daily. Severe infections: 15ml. 6 weeks-5 months: 1.25ml diluted and infused twice daily; 6 months-5 years: 2.5ml; 6-12 years: 5ml

Contraindications:

Megaloblastic anemia due to folate deficiency, infants <2 mo

Side Effects:

Cautions:

Precautions:

Streptococcal pharyngitis, elderly patients receiving diuretics, renal and hepatic function impairment, possible folate deficiency (elderly, chronic alcoholics, anticonvulsant therapy, malabsorption syndrome, malnutrition), G-6-PD deficiency 

Interaction:

Drugs

Dapsone: Increased-dapsone and trimethoprim concentrations Disulfiram,

metronidazole: Co-trimoxazole contains 10% ethanol, disulfiram reaction possible

Methotrexate: Elevated methotrexate concentrations and toxicity Oral

anticoagulants: Enhanced hypoprothrombinemic response to warfarin and possibly other oral anticoagulants Oral

hypoglycemic: Increased potential for hypoglycemia

Phenytoin: Increased phenytoin concentrations

Warnings:

Adverse Effects:

Lactations:

Do not use at term, may cause kernicterus in, the neonate; not recommended , in the neonatal nursing period because sulfonamides excreted in breast milk may cause kernicterus 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety, aseptic meningitis, ataxia, chills, depression, fatigue, hallucinations, headache, insomnia, seizures, vertigo

GI: Abdominal pain, anorexia, diarrhea, glossitis, hepatitis, nausea, pancreatitis

pseudomembranous enterocolitis, stomatitis, vomiting

GU: Crystalluria, renal failure, toxic nephrosis

HEME: Agranulocytosis, eosinophilia, hemolytic anemia, leukopenia, methemoglobinemia, neutropenia, thrombocytopenia

RESP: Cough, shortness of breath

SKIN: Dermatitis, erythema, pain and inflammation at inj site; photosensitivity, rash, Stevens Johnson syndrome, urticaria

MISC.: Drug fever 

Patient And Carer Advice: