Trimethoprim

What is Trimethoprim

Trimethoprim is a synthetic antiinfective agent. It has activity against both gram-positive and gram-negative bacteria.

It is commonly used systemically for the treatment and prophylaxis of uncomplicated urinary tract infections, for traveler’s diarrhea, and, when combined with either sulfamethoxazole or dapsone, for prophylaxis and treatment of Pneumocystis infections.

Trimethoprim was originally available in combination with sulfamethoxazole in 1973, then was approved by the FDA for use as a single agent in 1980. It is also available in an ophthalmic solution in combination with polymyxin B.

Indications

  1. Acinetobacter sp.
  2. Citrobacter sp.
  3. cystitis
  4. Enterobacter sp.
  5. Escherichia coli
  6. Haemophilus influenzae (beta-lactamase negative)
  7. Haemophilus influenzae (beta-lactamase positive)
  8. Klebsiella pneumoniae
  9. otitis media
  10. Pneumocystis jirovecii (formerly Pneumocystis carinii)
  11. Pneumocystis pneumonia (PCP)
  12. Proteus mirabilis
  13. Salmonella sp.
  14. Shigella sp.
  15. Staphylococcus epidermidis
  16. Staphylococcus saprophyticus
  17. Streptococcus pneumoniae
  18. Streptococcus pyogenes (group A beta-hemolytic streptococci)
  19. urinary tract infection (UTI)
  20. urinary tract infection (UTI) prophylaxis

Side Effects

  1. abdominal pain
  2. acute generalized exanthematous pustulosis (AGEP)
  3. aseptic meningitis
  4. azotemia
  5. candidiasis
  6. cholestasis
  7. diarrhea
  8. elevated hepatic enzymes
  9. exfoliative dermatitis
  10. fever
  11. glossitis
  12. hyperbilirubinemia
  13. hyperkalemia
  14. hyponatremia
  15. jaundice
  16. leukopenia
  17. maculopapular rash
  18. megaloblastic anemia
  19. methemoglobinemia
  20. nausea
  21. neutropenia
  22. photosensitivity
  23. pruritus
  24. pseudomembranous colitis
  25. rash
  26. Stevens-Johnson syndrome
  27. superinfection
  28. thrombocytopenia
  29. toxic epidermal necrolysis
  30. vomiting

Monitoring Parameters

  • CBC
  • serum creatinine/BUN

Contraindications

  • breast-feeding
  • colitis
  • diarrhea
  • folate deficiency
  • folate deficiency megaloblastic anemia
  • geriatric
  • GI disease
  • hepatic disease
  • hyperkalemia
  • infants
  • inflammatory bowel disease
  • neonates
  • pregnancy
  • pseudomembranous colitis
  • renal disease
  • renal failure
  • renal impairment
  • ulcerative colitis

Interactions

  • Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
  • Aliskiren; Valsartan
  • Alogliptin; Pioglitazone
  • Amantadine
  • Amiloride
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Amlodipine; Benazepril
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Angiotensin II receptor antagonists
  • Angiotensin-converting enzyme inhibitors
  • Atovaquone
  • Atovaquone; Proguanil
  • Azathioprine
  • Azilsartan
  • Azilsartan; Chlorthalidone
  • Benazepril
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Candesartan
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Captopril
  • Captopril; Hydrochlorothiazide, HCTZ
  • Citric Acid; Potassium Citrate
  • Citric Acid; Potassium Citrate; Sodium Citrate
  • Dapsone
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate
  • Dienogest; Estradiol valerate
  • Digoxin
  • Dofetilide
  • Donepezil; Memantine
  • Drospirenone
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Elagolix; Estradiol; Norethindrone acetate
  • Eltrombopag
  • Enalapril, Enalaprilat
  • Enalapril; Felodipine
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Entecavir
  • Eplerenone
  • Eprosartan
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • 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
  • Fluorouracil, 5-FU
  • Folic Acid, Vitamin B9
  • Fosinopril
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • Fosphenytoin
  • Ganciclovir
  • Glimepiride; Pioglitazone
  • Glimepiride; Rosiglitazone
  • Guaifenesin; Potassium Guaiacolsulfonate
  • Hetastarch; Dextrose; Electrolytes
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone; Potassium Guaiacolsulfonate
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Ibritumomab Tiuxetan
  • Indinavir
  • Iodine; Potassium Iodide, KI
  • Irbesartan
  • Isoniazid, INH; Pyrazinamide, PZA; Rifampin
  • Isoniazid, INH; Rifampin
  • Lamivudine, 3TC; Zidovudine, ZDV
  • Lamotrigine
  • Leucovorin
  • Leuprolide; Norethindrone
  • Levoleucovorin
  • Levomefolate
  • Levonorgestrel
  • Lisinopril
  • Loperamide
  • Loperamide; Simethicone
  • Losartan
  • Mefenamic Acid
  • Memantine
  • Mestranol; Norethindrone
  • Metformin; Pioglitazone
  • Metformin; Repaglinide
  • Metformin; Rosiglitazone
  • Methotrexate
  • Moexipril
  • Nanoparticle Albumin-Bound Paclitaxel
  • Nebivolol; Valsartan
  • Norethindrone
  • Norgestrel
  • Olmesartan
  • Omeprazole; Amoxicillin; Rifabutin
  • Oral Contraceptives
  • Paclitaxel
  • Perindopril
  • Perindopril; Amlodipine
  • Phenytoin
  • Pioglitazone
  • Potassium
  • Potassium Acetate
  • Potassium Bicarbonate
  • Potassium Chloride
  • Potassium Citrate
  • Potassium Gluconate
  • Potassium Iodide, KI
  • Potassium Phosphate
  • Potassium Phosphate; Sodium Phosphate
  • Potassium-sparing diuretics
  • Pralatrexate
  • Procainamide
  • Pyrimethamine
  • Pyrimethamine; Sulfadoxine
  • Quinapril
  • Ramipril
  • Repaglinide
  • Rifabutin
  • Rifampin
  • Rosiglitazone
  • Sacubitril; Valsartan
  • Sapropterin
  • Segesterone Acetate; Ethinyl Estradiol
  • Selexipag
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Spironolactone
  • Telmisartan
  • Terbinafine
  • Tolbutamide
  • Trandolapril
  • Trandolapril; Verapamil
  • Triamterene
  • Trimetrexate
  • Trospium
  • Valganciclovir
  • Valproic Acid, Divalproex Sodium
  • Valsartan
  • Zidovudine, ZDV
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