Sulfamethoxazole and Trimethoprim SMX TMP Cotrimoxazole

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

  1. Acinetobacter baumannii
  2. Actinomadura madurae
  3. Actinomadura pelletierii
  4. actinomycotic mycetoma
  5. bacteremia
  6. bacteremia prophylaxis
  7. bacterial infection prophylaxis
  8. bone and joint infections
  9. Bordetella pertussis
  10. brain abscess
  11. bronchitis
  12. brucellosis
  13. Burkholderia pseudomallei
  14. cellulitis
  15. cholera
  16. Cyclospora cayetanensis
  17. cyclosporiasis
  18. cystitis
  19. endocarditis
  20. Enterobacter sp.
  21. Escherichia coli
  22. granuloma inguinale
  23. Haemophilus ducreyi
  24. Haemophilus influenzae (beta-lactamase negative)
  25. Haemophilus influenzae (beta-lactamase positive)
  26. infectious arthritis
  27. Isospora belli
  28. isosporiasis
  29. Klebsiella granulomatis
  30. Klebsiella sp.
  31. Legionella micdadei
  32. Legionella pneumophila
  33. Legionnaire’s disease
  34. Listeria monocytogenes
  35. mastitis
  36. melioidosis
  37. meningitis
  38. Moraxella catarrhalis
  39. Morganella morganii
  40. Neisseria gonorrhoeae
  41. Nocardia asteroides
  42. Nocardia brasiliensis
  43. Nocardia otitidiscaviarum
  44. nocardiosis
  45. orthopedic device-related infection
  46. osteomyelitis
  47. otitis media
  48. pediculosis
  49. Pediculus capitis
  50. peritonitis
  51. peritonitis prophylaxis
  52. pertussis (whooping cough)
  53. pertussis prophylaxis
  54. Plasmodium falciparum
  55. Pneumocystis jirovecii (formerly Pneumocystis carinii)
  56. Pneumocystis pneumonia (PCP)
  57. Pneumocystis pneumonia (PCP) prophylaxis
  58. Proteus mirabilis
  59. Proteus sp.
  60. Proteus vulgaris
  61. Providencia sp.
  62. pyelonephritis
  63. Q fever
  64. Salmonella sp.
  65. salmonellosis
  66. Serratia sp.
  67. Shigella flexneri
  68. Shigella sonnei
  69. Shigella sp.
  70. shigellosis
  71. skin and skin structure infections
  72. Staphylococcus aureus (MRSA)
  73. Staphylococcus aureus (MSSA)
  74. Staphylococcus epidermidis
  75. Stenotrophomonas maltophilia
  76. Streptococcus pneumoniae
  77. Streptococcus pyogenes (group A beta-hemolytic streptococci)
  78. Streptomyces somaliensis
  79. subdural empyema
  80. sulfonamide desensitization
  81. surgical infection prophylaxis
  82. Toxoplasma gondii
  83. toxoplasmic encephalitis
  84. toxoplasmosis prophylaxis
  85. traveler’s diarrhea
  86. typhoid fever
  87. urinary tract infection (UTI)
  88. urinary tract infection (UTI) prophylaxis
  89. Vibrio cholerae
  90. Viridans streptococci
  91. Yersinia enterocolitica

Side Effects

  1. abdominal pain
  2. acute generalized exanthematous pustulosis (AGEP)
  3. agranulocytosis
  4. anaphylactic shock
  5. anaphylactoid reactions
  6. angioedema
  7. anorexia
  8. anuria
  9. aplastic anemia
  10. arthralgia
  11. aseptic meningitis
  12. ataxia
  13. azotemia
  14. bullous rash
  15. chills
  16. cough
  17. crystalluria
  18. depression
  19. diarrhea
  20. diuresis
  21. dyspnea
  22. dysuria
  23. elevated hepatic enzymes
  24. eosinophilia
  25. erythema multiforme
  26. erythema nodosum
  27. exfoliative dermatitis
  28. fatigue
  29. fever
  30. glossitis
  31. hallucinations
  32. headache
  33. hemolytic anemia
  34. hepatic necrosis
  35. hepatitis
  36. hyperkalemia
  37. hypoglycemia
  38. hyponatremia
  39. hypoprothrombinemia
  40. injection site reaction
  41. insomnia
  42. interstitial nephritis
  43. jaundice
  44. leukopenia
  45. lupus-like symptoms
  46. maculopapular rash
  47. megaloblastic anemia
  48. metabolic acidosis
  49. methemoglobinemia
  50. myalgia
  51. myocarditis
  52. nausea
  53. neuritis
  54. neutropenia
  55. oliguria
  56. pancreatitis
  57. periarteritis
  58. phlebitis
  59. photosensitivity
  60. pruritus
  61. pseudomembranous colitis
  62. purpura
  63. QT prolongation
  64. rash
  65. renal failure (unspecified)
  66. renal tubular necrosis
  67. rhabdomyolysis
  68. seizures
  69. serum sickness
  70. Stevens-Johnson syndrome
  71. stomatitis
  72. thrombocytopenia
  73. thrombotic thrombocytopenic purpura (TTP)
  74. tinnitus
  75. torsade de pointes
  76. toxic epidermal necrolysis
  77. urticaria
  78. uveitis
  79. vasculitis
  80. ventricular tachycardia
  81. vertigo
  82. vomiting
  83. 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
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