Sulfamethoxazole and Trimethoprim (Co-trimoxazole) |Shetrim


Indication

Treatment of choice for pneumonia due to Pneumocystic carinii and also infections due to Nocardia asteroids. It may be used to treat typhoid and paratyphoid infections; dictostrains of Shigella resistant to Amoxicillin. Invasive salmonellosis, bone and joint infections due to H.Influenza, urinary tract infections, sinusitis, exacerbation of chronic bronchitis and gonorrhea in penicillin allergic patients
It may be used to treat typhoid and paratyphoid infections; dictostrains of Shigella resistant to Amoxicillin

Dosage regimen and directions for use: As directed by physician or

Adult: 960 mg every 12 hours increased to 1.44g in severe infections
            480 mg every 12 hours if treated for more than 14 days
Children: six weeks to five months, 120 mg every every 12 hours, six months to five years 240 mg every twelve hours; six to twelve years 480 mg every 12 hours
For gonorrhea cure: 1.92g every 12 hours for two days or 2.4 mg followed by a further dose of 2.4 mg after 8 hours





Directions for reconstitution:

Shake the bottle before adding water. Measure 7o ml of previously boiled and cooled water and add it to the powder for oral suspension in 2 portions and agitate vigorously immediately after each to sulpha drugs.

Contraindications

It is contraindicated in pregnancy, in infants under six weeks (due to risk of kernicterus), internal and hepatic failure, and jaundice and blood conditions. It is contraindicated to the patients with allergy to sulpha drugs.

Side effects and adverse reactions

These include: nausea, vomiting, diarrhea, headache, dizziness, skin rashes, acidosis, anorexia, stomatitis, goiter, drowsiness, fatigue, insomnia, confusion, ataxia, crystalluria may occur. High doses of Co-trimoxazole may cause macrocytic anaemia due to difference with conversion of Folic acid to Folinic acid.

Precautions and warnings

Adequate fluid intake is necessary to reduce the risk of crystalluria. Daily urine output should be 1500ml or more. Treatment to be discontinued immediately, if a rash appears because of the danger of severe allergic reactions. Avoid administration to hypersensitive patients. Direct exposure to sunlight to be avoided during treatment with Co-trimoxazole.

Symptoms and treatment of overdose

Symptoms: Mainly nausea, vomiting and rashes
Treatment: Gastric lavage, take large quantities of fluids and urine alkanization with potassium citrate. Symptomatic treatment shall be given



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