What is Sulfamethoxazole and Trimethoprim SMX TMP Cotrimoxazole
Sulfamethoxazole; trimethoprim (also known as co-trimoxazole or TMP-SMX) is a combination product of trimethoprim and sulfamethoxazole in a fixed 1:5 ratio. This dosage ratio produces serum concentrations of 1:20, which optimize antibacterial activity against some organisms.
Both trimethoprim and sulfamethoxazole are synthetic folate antagonists that are effective antimicrobials as individual agents.
Sulfamethoxazole; trimethoprim initially was used in the treatment of UTIs but has since proved to be a versatile agent and now is widely used in the prevention and treatment of Pneumocystis pneumonia.
Sulfamethoxazole; trimethoprim was approved by the FDA in 1973.
Indications
- Acinetobacter baumannii
- Actinomadura madurae
- Actinomadura pelletierii
- actinomycotic mycetoma
- bacteremia
- bacteremia prophylaxis
- bacterial infection prophylaxis
- bone and joint infections
- Bordetella pertussis
- brain abscess
- bronchitis
- brucellosis
- Burkholderia pseudomallei
- cellulitis
- cholera
- Cyclospora cayetanensis
- cyclosporiasis
- cystitis
- endocarditis
- Enterobacter sp.
- Escherichia coli
- granuloma inguinale
- Haemophilus ducreyi
- Haemophilus influenzae (beta-lactamase negative)
- Haemophilus influenzae (beta-lactamase positive)
- infectious arthritis
- Isospora belli
- isosporiasis
- Klebsiella granulomatis
- Klebsiella sp.
- Legionella micdadei
- Legionella pneumophila
- Legionnaire’s disease
- Listeria monocytogenes
- mastitis
- melioidosis
- meningitis
- Moraxella catarrhalis
- Morganella morganii
- Neisseria gonorrhoeae
- Nocardia asteroides
- Nocardia brasiliensis
- Nocardia otitidiscaviarum
- nocardiosis
- orthopedic device-related infection
- osteomyelitis
- otitis media
- pediculosis
- Pediculus capitis
- peritonitis
- peritonitis prophylaxis
- pertussis (whooping cough)
- pertussis prophylaxis
- Plasmodium falciparum
- Pneumocystis jirovecii (formerly Pneumocystis carinii)
- Pneumocystis pneumonia (PCP)
- Pneumocystis pneumonia (PCP) prophylaxis
- Proteus mirabilis
- Proteus sp.
- Proteus vulgaris
- Providencia sp.
- pyelonephritis
- Q fever
- Salmonella sp.
- salmonellosis
- Serratia sp.
- Shigella flexneri
- Shigella sonnei
- Shigella sp.
- shigellosis
- skin and skin structure infections
- Staphylococcus aureus (MRSA)
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- Stenotrophomonas maltophilia
- Streptococcus pneumoniae
- Streptococcus pyogenes (group A beta-hemolytic streptococci)
- Streptomyces somaliensis
- subdural empyema
- sulfonamide desensitization
- surgical infection prophylaxis
- Toxoplasma gondii
- toxoplasmic encephalitis
- toxoplasmosis prophylaxis
- traveler’s diarrhea
- typhoid fever
- urinary tract infection (UTI)
- urinary tract infection (UTI) prophylaxis
- Vibrio cholerae
- Viridans streptococci
- Yersinia enterocolitica
Side Effects
- abdominal pain
- acute generalized exanthematous pustulosis (AGEP)
- agranulocytosis
- anaphylactic shock
- anaphylactoid reactions
- angioedema
- anorexia
- anuria
- aplastic anemia
- arthralgia
- aseptic meningitis
- ataxia
- azotemia
- bullous rash
- chills
- cough
- crystalluria
- depression
- diarrhea
- diuresis
- dyspnea
- dysuria
- elevated hepatic enzymes
- eosinophilia
- erythema multiforme
- erythema nodosum
- exfoliative dermatitis
- fatigue
- fever
- glossitis
- hallucinations
- headache
- hemolytic anemia
- hepatic necrosis
- hepatitis
- hyperkalemia
- hypoglycemia
- hyponatremia
- hypoprothrombinemia
- injection site reaction
- insomnia
- interstitial nephritis
- jaundice
- leukopenia
- lupus-like symptoms
- maculopapular rash
- megaloblastic anemia
- metabolic acidosis
- methemoglobinemia
- myalgia
- myocarditis
- nausea
- neuritis
- neutropenia
- oliguria
- pancreatitis
- periarteritis
- phlebitis
- photosensitivity
- pruritus
- pseudomembranous colitis
- purpura
- QT prolongation
- rash
- renal failure (unspecified)
- renal tubular necrosis
- rhabdomyolysis
- seizures
- serum sickness
- Stevens-Johnson syndrome
- stomatitis
- thrombocytopenia
- thrombotic thrombocytopenic purpura (TTP)
- tinnitus
- torsade de pointes
- toxic epidermal necrolysis
- urticaria
- uveitis
- vasculitis
- ventricular tachycardia
- vertigo
- vomiting
- weakness
Monitoring Parameters
- CBC with differential
- glucose-6-phosphate dehydrogenase (G6PD) activity
- LFTs
- serum creatinine/BUN
Contraindications
- acquired immunodeficiency syndrome (AIDS)
- agranulocytosis
- alcoholism
- antimicrobial resistance
- bone marrow suppression
- bradycardia
- breast-feeding
- carbonic anhydrase inhibitor hypersensitivity
- cardiac arrhythmias
- cardiac disease
- colitis
- coronary artery disease
- diabetes mellitus
- diarrhea
- females
- folate deficiency
- folate deficiency megaloblastic anemia
- G6PD deficiency
- geriatric
- GI disease
- heart failure
- hemolysis
- hepatic disease
- hyperkalemia
- hypertension
- hypocalcemia
- hypoglycemia
- hypokalemia
- hypomagnesemia
- hyponatremia
- hypothyroidism
- infants
- inflammatory bowel disease
- laboratory test interference
- long QT syndrome
- malnutrition
- myocardial infarction
- neonates
- porphyria
- pregnancy
- pseudomembranous colitis
- QT prolongation
- renal disease
- renal failure
- renal impairment
- sulfite hypersensitivity
- sulfonamide hypersensitivity
- sulfonylurea hypersensitivity
- sunlight (UV) exposure
- thiazide diuretic hypersensitivity
- thrombocytopenia
- thyroid disease
- trimethoprim hypersensitivity
- ulcerative colitis
- viral infection
Interactions
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Acarbose
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Acetohexamide
- Albiglutide
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Alogliptin; Metformin
- Alogliptin; Pioglitazone
- Alpha-glucosidase Inhibitors
- Amantadine
- Amiloride
- Amiloride; Hydrochlorothiazide, HCTZ
- Aminosalicylate sodium, Aminosalicylic acid
- Amlodipine; Benazepril
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amoxicillin
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amoxicillin; Clavulanic Acid
- Ampicillin
- Ampicillin; Sulbactam
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Aprepitant, Fosaprepitant
- Articaine; Epinephrine
- Aspirin, ASA
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Aspirin, ASA; Carisoprodol
- Aspirin, ASA; Carisoprodol; Codeine
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Dipyridamole
- Aspirin, ASA; Omeprazole
- Aspirin, ASA; Oxycodone
- Aspirin, ASA; Pravastatin
- Atenolol; Chlorthalidone
- Atovaquone
- Atovaquone; Proguanil
- Atropine; Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Azathioprine
- Azilsartan
- Azilsartan; Chlorthalidone
- Benazepril
- Benazepril; Hydrochlorothiazide, HCTZ
- Bendroflumethiazide; Nadolol
- Benzocaine
- Benzocaine; Butamben; Tetracaine
- Benzoic Acid; Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate
- Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
- Bismuth Subsalicylate
- Bismuth Subsalicylate; Metronidazole; Tetracycline
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Boceprevir
- Bosentan
- Bromocriptine
- Bupivacaine
- Bupivacaine Liposomal
- Bupivacaine; Lidocaine
- Canagliflozin
- Canagliflozin; Metformin
- Candesartan
- Candesartan; Hydrochlorothiazide, HCTZ
- Captopril
- Captopril; Hydrochlorothiazide, HCTZ
- Carbamazepine
- Chloramphenicol
- Chloroprocaine
- Chlorothiazide
- Chlorpropamide
- Chlorthalidone
- Chlorthalidone; Clonidine
- Choline Salicylate; Magnesium Salicylate
- Citric Acid; Potassium Citrate
- Citric Acid; Potassium Citrate; Sodium Citrate
- Colchicine; Probenecid
- Cyclosporine
- Dapagliflozin
- Dapagliflozin; Metformin
- Dapagliflozin; Saxagliptin
- Dapsone
- Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
- Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
- Dicloxacillin
- Dienogest; Estradiol valerate
- Digoxin
- Dipeptidyl Peptidase-4 Inhibitors
- Diphenhydramine; Naproxen
- Disulfiram
- Dofetilide
- Donepezil; Memantine
- Doxercalciferol
- Dronabinol
- Drospirenone
- Drospirenone; Estradiol
- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
- Dulaglutide
- Elagolix; Estradiol; Norethindrone acetate
- Elexacaftor; tezacaftor; ivacaftor
- Eltrombopag
- Elvitegravir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Empagliflozin
- Empagliflozin; Linagliptin
- Empagliflozin; Linagliptin; Metformin
- Empagliflozin; Metformin
- Enalapril, Enalaprilat
- Enalapril; Felodipine
- Enalapril; Hydrochlorothiazide, HCTZ
- Entecavir
- Eplerenone
- Eprosartan
- Eprosartan; Hydrochlorothiazide, HCTZ
- Erdafitinib
- Ertugliflozin
- Ertugliflozin; Metformin
- Ertugliflozin; Sitagliptin
- Esomeprazole; Naproxen
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Exenatide
- Fenofibric Acid
- Fenoprofen
- Fluorouracil, 5-FU
- Fluvastatin
- Folic Acid, Vitamin B9
- food
- Fosinopril
- Fosinopril; Hydrochlorothiazide, HCTZ
- Fosphenytoin
- Ganciclovir
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Guaifenesin; Potassium Guaiacolsulfonate
- Hetastarch; Dextrose; Electrolytes
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Olmesartan
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrochlorothiazide, HCTZ; Valsartan
- Hydrocodone; Potassium Guaiacolsulfonate
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hyoscyamine; Methenamine; Methylene Blue; Phenyl Salicylate; Sodium Biphosphate
- Ibritumomab Tiuxetan
- Incretin Mimetics
- Indinavir
- Indomethacin
- Insulin Degludec; Liraglutide
- Insulin Glargine; Lixisenatide
- Insulins
- Iodine; Potassium Iodide, KI
- Irbesartan
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Ivacaftor
- Lamivudine, 3TC; Zidovudine, ZDV
- Lamotrigine
- Lansoprazole; Naproxen
- Lesinurad
- Lesinurad; Allopurinol
- Leucovorin
- Leuprolide; Norethindrone
- Levoleucovorin
- Levomefolate
- Levonorgestrel
- Lidocaine
- Linagliptin; Metformin
- Liraglutide
- Lisinopril
- Lixisenatide
- Loperamide
- Loperamide; Simethicone
- Losartan
- Lumacaftor; Ivacaftor
- Lumacaftor; Ivacaftor
- Magnesium Salicylate
- Mefenamic Acid
- Meglitinides
- Meloxicam
- Memantine
- Mepivacaine
- Mepivacaine; Levonordefrin
- Mercaptopurine, 6-MP
- Mestranol; Norethindrone
- Metformin
- Metformin; Pioglitazone
- Metformin; Repaglinide
- Metformin; Rosiglitazone
- Metformin; Saxagliptin
- Metformin; Sitagliptin
- Methenamine
- Methenamine; Sodium Acid Phosphate
- Methenamine; Sodium Acid Phosphate; Methylene Blue; Hyoscyamine
- Methotrexate
- Methoxsalen
- Methyclothiazide
- Metolazone
- Metronidazole
- Miglitol
- Moexipril
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nebivolol; Valsartan
- Norethindrone
- Norgestrel
- Olmesartan
- Omeprazole; Amoxicillin; Rifabutin
- Oral Contraceptives
- Oritavancin
- Oxacillin
- Paclitaxel
- Penicillin G
- Penicillin G Benzathine
- Penicillin G Benzathine; Penicillin G Procaine
- Penicillin G Procaine
- Penicillin V
- Perindopril
- Perindopril; Amlodipine
- Pexidartinib
- Phenytoin
- Photosensitizing agents (topical)
- Pioglitazone
- Piperacillin
- Piperacillin; Tazobactam
- Porfimer
- Posaconazole
- Potassium
- Potassium Acetate
- Potassium Bicarbonate
- Potassium Chloride
- Potassium Citrate
- Potassium Gluconate
- Potassium Iodide, KI
- Potassium Phosphate
- Potassium Phosphate; Sodium Phosphate
- Potassium-sparing diuretics
- Pralatrexate
- Pramlintide
- Prilocaine
- Prilocaine; Epinephrine
- Probenecid
- Procainamide
- Pyrimethamine
- Pyrimethamine; Sulfadoxine
- Quinapril
- Ramelteon
- Ramipril
- Repaglinide
- Rifabutin
- Rifampin
- Riluzole
- Ropivacaine
- Rosiglitazone
- Sacubitril; Valsartan
- Salicylates
- Salsalate
- Sapropterin
- Segesterone Acetate; Ethinyl Estradiol
- Selexipag
- Semaglutide
- SGLT2 Inhibitors
- Siponimod
- Sodium Iodide
- Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Spironolactone
- Sulfinpyrazone
- Sulfonylureas
- Telaprevir
- Telmisartan
- Terbinafine
- Tetracaine
- Tezacaftor; Ivacaftor
- Thiazide diuretics
- Thiazolidinediones
- Tolazamide
- Tolbutamide
- Trandolapril
- Trandolapril; Verapamil
- Triamterene
- Trimetrexate
- Trospium
- Typhoid Vaccine
- Valganciclovir
- Valproic Acid, Divalproex Sodium
- Valsartan
- Verteporfin
- Vigabatrin
- Voriconazole
- Warfarin
- Zidovudine, ZDV
- Ziprasidone
