Co-trimoxazole
Review literature: (Simon and Stille, 1997).
Co-trimoxazole is an antibiotic with a fixed combination of trimethoprim (dihydrofolate reductase inhibitor) and sulfamethoxazole (sulfonamide).
Mechanism of Action of Co-trimoxazole
Co-trimoxazole is bactericidal due to the double inhibition of bacterial folic acid synthesis.
Antibiotic Spectrum of Co-trimoxazole:
Bacteria causing urinary tract infection such as E. coli, Enterococci, Mycoplasma, Klebsiella, Serratia, Enterobacter (KES group), but with increasing resistance rates.
Urologic Indications for Co-trimoxazole:
Treatment or prevention of urinary tract infection.
Pharmacokinetics of Co-trimoxazole
- Elimination half life 10–12 h.
- Renal elimination 60% (trimethoprim) to 90% (sulfamethoxazole)
Side Effects of Co-trimoxazole
Allergy:
Skin rash, rarely severe skin reactions (Stevens-Johnson and Lyell's syndrome).
Kidney:
Exacerbation of renal failure (reversible).
Blood:
Bone marrow depression in case of long-term therapy, rarely agranulocytosis.
Drug Interactions with Co-trimoxazole
Co-trimoxazole enhances the effect of phenytoin and sulfonylureas. Increased toxicity of cyclosporine, barbiturates, p-aminosalicylic acid and methotrexate.
Contraindications of Co-trimoxazole
- Folic acid deficiency
- Severe liver disease
- Renal failure
- Pregnancy, newborns
- Glucose-6-phosphate dehydrogenase deficiency
- Acute hepatic porphyria
- Bone marrow insufficiency
Dosage of Co-trimoxazole
The ratio between trimethoprim and sulfamethoxazole is 1:5. The dosage for adults is 480 mg (80 mg trimethoprim and 400 mg sulfamethoxazole) 1-0-1 p.o. to 960 mg p.o. 1-0-1. The dosage for children is 24 mg/kg p.o. co-trimoxazole 1-0-1.
In uncomplicated acute cystitis of women, co-trimoxazole is given for 3 days. In any other urinary tract infection, the recommended treatment duration is at least 7 days.
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References
- Simon und Stille 1997 SIMON, C. ; STILLE, W.:
- Antibiotika-Therapie in Klinik und Praxis.
9. Auflage.
Stuttgart New York : Schattauer, 1997
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Deutsche Version: Cotrimoxazol
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Dr. med. Dirk Manski
man...@urologielehrbuch.de