Spectrum: Local Antimicrobial Stewardship, for Prisma Health Children’s Hospital-Midlands

Sulfamethoxazole-Trimethoprim

C. diff Risk

Medium

Oral Bioavailability

Excellent (90 to 100%)

Approximate Cost

IV$$$ PO$

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

General Spectrum of Activity

Antibiogram Data

Dosing

Pediatric

Renal

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing

General Information

Common Usage

Common Usage

  • Urinary tract infections

  • MRSA infections

  • Stenotrophomonas infections

  • Pneumocystis jirovecii pneumonia (treatment or prophylaxis)

Drug Monitoring

Drug Monitoring

Follow creatinine and electrolytes in patients at increased risk renal failure

Hyperkalemia

CBC for cytopenias

Adverse Effects

Adverse Effects

  • Stevens Johnson syndrome/toxic epidermal necrolysis

  • Other rashes

  • Gastrointestinal upset common

  • Bone marrow suppression

  • Hyperkalemia

  • Renal failure

  • Hepatitis

  • Aseptic meningitis

Major Interactions

Major Interactions

ACEi - increased serum potassium level

Methotrexate - marrow suppression

Increases phenytoin

Increases INR with warfarin

Additional Information

Additional Information

Regular strength tablets 400mg SMX/ 80 mg TMP

Double strength tablets 800 mg SMX/ 160mg TMP

Pharmacology

Pharmacology

Antimicrobial class: Sulfonamide - Antifolate

Average serum half life: TMP (prolonged in renal failure) Newborns: ~19 hours; range: 11-27 hours
infants 2 months to 1 year: ~4.6 hours; range: 3-6 hours.
Children 1-10 years: 3.7-5.5 hours.
Children and Adolescents >10 years: 8.19 hours
Adults: 6-11 hours
SMX: 9-12 hours, prolonged in renal failure (Adult data)

Route of Elimination: Both excreted in urine as metabolites and unchanged drug