Bactrim

For Patients With Impaired Renal Function: When renal function is impaired, a reduced dosage should be employed using the following table:

Acute Exacerbations of Chronic Bronchitis in Adults: Bactrim 2x2 o pc 14 days.

Travelers’ Diarrhea in Adults: Septra 2x2 o pc x 5 days.

Pneumocystis carinii Pneumonia: Treatment:

Adults and Pediatric Patients:

The recommended dosage for treatment of patients with documented Pneumocystis carinii pneumonia is

15 to 20 mg/kg TMP and 75 to 100 mg/kg SMT in 24 hours divided doses q 6 hrs for 14 to 21 days.

Ex.

10 kg = 15*10 = 150 mg/day = 37.5 mg qid = 1 tsp qid

10 kg = 20*10 = 200 mg/day = 50 mg qid = 11/4 tsp qid

10 kg = 20*8 = 160 mg/day = 40 mg qid = 1 tsp qid

The following table is a guide-line for the upper limit of this dosage:

For the lower limit dose (15 mg/kg trimethoprim and 75 mg/kg sulfamethoxazole per 24 hours) administer 75% of the dose in the above table.

Prophylaxis:PCP

Adults: Bactrim 2t od

The recommended dosage for prophylaxis in adults is one SEPTRA DS (double strength) tablet daily.

Pediatric Patients:

For pediatric patients, the recommended dose is 150 mg/m2/day trimethoprim with 750 mg/m2/day sulfamethoxazole given orally in equally divided doses twice a day, on 3 consecutive days per week. The total daily dose should not exceed 320 mg trimethoprim and 1,600 mg sulfamethoxazole. The following table is a guideline for the attainment of this dosage in pediatric patients:

Patients who receive cotrimoxazole intravenously or orally and have impaired renal function should be dosed according to the following dosage schedule:

Creatinine Clearance Dosage (mL/min)

Above 30: Standard regimen

15-30: 1/2 standard regimen

Below 15: Not recommended

Non-PCP:

[>30 ml/min]: no change

[15-30]: 2.5 mg/kg q12h

[<15 ml/min]: not recommended by manufacturer.

Alternative (LESS SUPPORT): 2.5mg/kg q24h (Avoid if possible due to risk of crystalluria/ nephrolithiasis)

PCP:

[>30 ml/min]: no change

[15-30]: 5mg/kg q12h

[<15 ml/min]: not recommended by manufacturer.

Alternative (LESS SUPPORT): 5mg/kg q24h (Avoid if possible due to risk of crystalluria/ nephrolithiasis)

Hemodialysis:

Not recommended by manufacturer.

Alternative (LESS SUPPORT):

Oral: Avoid if possible. If unavoidable, give one SS/DS q24h.

IV: Avoid if possible. If unavoidable, give 5mg/kg q24h.

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Micromedex

Guidelines for the administration of cotrimoxazole (based on the trimethoprim component) in patients with renal dysfunctions (Paap & Nahata, 1995; Paap & Nahata, 1989):

INDICATION/RENAL FUNCTION DOSE

PCP TREATMENT

CrCl > than 30 ml/min

15-20 mg/kg/day divided q6-8h

CrCl 15 to 30 ml/min

15-20 mg/kg/day divided q6-8h for 48h then 7-10 mg/kg/day divided q12h

CrCl < 15 ml/min

15-20 mg/kg/dose q48h (or 7-10 mg/kg/day divided q12-24h)

Hemodialysis

15-20 mg/kg/dose before dialysis and 7-10 mg/kg/dose after dialysis

PCP PROPHYLAXIS

CrCl > 30 ml/min

5 mg/kg q24h for 3 to 7 doses/week

CrCl 15 to 30 ml/min

5 mg/kg q24-48h for 3 to 7 doses/week

CrCl < 15 ml/min

5 mg/kg q48-72h

Hemodialysis

5 mg/kg after dialysis

OTHER INFECTIONS

CrCl greater than 30 ml/min

8-12 mg/kg/day divided q12h for 14 days then 4-6 mg/kg q24h

CrCl 15 to 30 ml/min

8-12 mg/kg/day divided q12h for 1-2 days then 4-6 mg/kg/day q24h

CrCl less than 15 ml/min

8-12 mg/kg/dose q48h (or 4-6 mg/kg/day divided q12-24h)

Hemodialysis

8-12 mg/kg/dose before dialysis and 4-6 mg/kg/dose after dialysis

Hemodialysis

INDICATIONS

Urinary Tract Infections: For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii,Proteus mirabilis, and Proteus vulgaris. It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination.

Acute Otitis Media: For the treatment of acute otitis media in pediatric patients due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when, in the judgment of the physician, SEPTRA offers some advantage over the use of other antimicrobial agents. To date, there are limited data on the safety of repeated use of SEPTRA in pediatric patients under two years of age. SEPTRA is not indicated for prophylactic or prolonged administration in otitis media at any age. Acute Exacerbations of Chronic Bronchitis in Adults: For the treatment of acute exacerbations of chronic bronchitis due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when, in the judgment of the physician, SEPTRA offers some advantage over the use of a single antimicrobial agent.

Travelers’ Diarrhea in Adults: For the treatment of travelers’ diarrhea due to susceptible strains of enterotoxigenic E. coli.

Shigellosis: For the treatment of enteritis caused by susceptible strains of Shigella flexneri and Shigella sonnei when antibacterial therapy is indicated.

Pneumocystis carinii Pneumonia: For the treatment of documented Pneumocystis carinii pneumonia. For prophylaxis against Pneumocystis carinii pneumonia in individuals who are immunosuppressed and considered to be at an increased risk of developing Pneumocystis carinii pneumonia.

HOW SUPPLIED

TABLETS (pink, scored, round-shaped) containing 80 mg trimethoprim and 400 mg sulfamethoxazole: Bottles of 100 (NDC 61570-052-01). Imprint on tablets “M052”.

DS (DOUBLE STRENGTH) TABLETS (pink, scored, oval-shaped) containing 160 mg trimethoprim and 800 mg sulfamethoxazole: Bottles of 20 (NDC 61570-053-20), 100 (NDC 61570-053-01), 250 (NDC 61570-053-52) and 500 (NDC 61570-053-05). Imprint on tablets “M053”.

ORAL SUSPENSIONS (pink, cherry-flavored) containing 40 mg trimethoprim and 200 mg sulfamethoxazole in each teaspoonful (5 mL): Bottle of 1 pint (473 mL) (NDC 61570-050-16) and 100 mL–package of 6 (NDC 61570-050-11); and (purple, grape-flavored) containing 40 mg trimethoprim and 200 mg sulfamethoxazole in each teaspoonful (5 mL): Bottle of 1 pint (473 mL) (NDC 61570-051-16).

Tablets should be stored at 15° to 25°C (59° to 77°F) in a dry place and protected from light.

Suspensions should be stored at 15° to 25°C (59° to 77°F) and protected from light.

Also available:

SEPTRA I.V. Infusion: 5 mL vials, containing 80 mg trimethoprim (16 mg/mL) and 400 mg sulfamethoxazole (80 mg/mL), tray of 10;

10 mL multiple dose vials containing 160 mg trimethoprim (16 mg/mL) and 800 mg sulfamethoxazole (80 mg/mL), tray of 10;

20 mL multiple dose vials containing 320 mg trimethoprim (16 mg/mL) and 1600 mg sulfamethoxazole (80 mg/mL), tray of 10.

Rx Only

Prescribing Information as of August 2005.

FDA rev date: 7/28/2005

Bactrim reference

http://www.rxlist.com Search drug information A-Z drug select left column, description, clinical pharmacology, indication and dosage, side effect.....

http://www.rxlist.com/cgi/generic/trisulf_ids.htm bactrim

http://www.fda.gov/cder/foi/label/2003/17377slr057_Bactrim_lbl.pdf