Co-trimoxazole [Sulfamethoxazole + Trimethoprim]
Sulfamethoxazole 400 mg Trimethoprim 80 mg
Combined antimicrobial drug consisting of sulfamethoxazole and trimethoprim. Sulfamethoxazole, similar in structure to para-aminobenzoic acid (PABA), disrupts the synthesis of dihydrofolic acid in bacterial cells, preventing the inclusion of PABA in its molecule. Trimethoprim enhances the action of sulfamethoxazole, disrupting the reduction of dihydrofolic acid to tetrahydrofolic acid - the active form of folic acid, which is responsible for protein metabolism and the division of microbial cells. It is a broad-spectrum bactericidal drug, active against the following microorganisms: Streptococcus spp. (hemolytic strains are more sensitive to penicillin), Staphylococcus spp., Streptococcus pneumoniae, Neisseria meningitidis, Neisseria gonorrhoeae, Escherichia coli (including enterotoxogenic strains), Salmonella spp. (including Salmonella typhi and Salmonella paratyphi), Vibrio cholerae, Bacillus anthracis, Haemophilus influenzae (including ampicillin-resistant strains), Listeria spp., Nocardia asteroides, Bordetella pertussis, Enterocate, you will be the form of the word for people, in-person and people, in-person and people, in-person and people, in-person and people, in Nocardia asteroides, Bordetella pertussis, Enterocate, inoculatory education, in Russian, in Russian, German, Russian, Russian, Russian, Russian, Russian, Russian, Russian, Russian, Russian, Russian, Russian, Russian, Russian, French, Russian, French, Russian, French, English , Brucella spp., Mycobacterium spp. (including Mycobacterium leprae), Citrobacter, Enterobacter spp., Legionella pneumophila, Providencia, some species of Pseudomonas (except Pseudomonas aeruginosa), Serratia marcescens, Shigella spp., Yersinia spp., Morganella spp., Shigella spp., Yersinia spp., Morganella spp., Shigella spp., Yersinia spp., Morganella spp. Chlamydia spp. (including Chlamydia trachomatis, Chlamydia psittaci). protozoa: Plasmodium spp., Toxoplasma gondii, pathogenic fungi, Actinomyces israelii, Coccidioides immitis, Histoplasma capsulatum, Leishmania spp. Resistant to the drug: Corynebacterium spp., Pseudomonas aeruginosa, Mycobacterium tuberculosis, Treponema spp., Leptospira spp., Viruses. Inhibits the vital activity of Escherichia coli, which leads to a decrease in the synthesis of thymine, riboflavin, nicotinic acid and other B vitamins in the intestine.
Co-trimoxazole is recommended for diseases associated with susceptible pathogenic flora. Conditions in which Co-trimoxazole is indicated: - ENT-practice: laryngitis, otitis media, sinusitis. - pathologies of the respiratory tract: bronchiectasis, bronchitis (indications are both acute and chronic, and the need to prevent exacerbations), pleural empyema, pneumonia (treatment and for prevention), lung abscess. Co-trimoxazole can be used for pneumonia associated with Pneumocystis carinii in people with AIDS. - Dermatology: acne, pyoderma, tissue abscesses, boils, infection of wounds. - Gastroenterology: diarrhea of bacterial origin, cholera (in combination with other drugs), shigellosis, paratyphoid fever, typhoid fever, gastroenteritis (associated with E.coli), cholangitis, cholecystitis. - urological practice: pyelitis, pyelonephritis, acute and chronic forms of cystitis, urethritis, epididymitis, prostatitis. - sexually transmitted diseases: gonorrhea, inguinal granuloma, sexually transmitted lymphogranuloma, soft chancre. - surgery and other infections: inflammation of the meninges, brain abscess, malaria, septicemia, whooping cough (combined with other drugs), toxoplasmosis, osteomyelitis (both chronic and acute), brucellosis, South American blastomycosis.
- intolerance to existing and auxiliary components. - impaired liver function (severe form). - insufficiency of excretory function of the kidneys (creatinine clearance less than 15 ml / min). - pathologies of blood formation: B12-deficient anemia, leukopenia, agranulocytosis. - lack of glucose-6-phosphate dehydrogenase. - age less than 2 months. - breastfeeding, pregnancy. Relative contraindications (the drug can be administered under the supervision of a physician): - insufficient renal excretory function (15-30 ml / min. Creatinine clearance) - Co-trimoxazole is prescribed in usual doses for the first 3 days of treatment, then reduce the dose by half. - potential folic acid deficiency. - propensity to allergic type reactions. - bronchial asthma . - moderately impaired thyroid function and liver. - Elderly patients (additional prescription of folic acid drugs is required). Co-trimoxazole is not a first-line agent for infections associated with beta-hemolytic streptococcus group A (considering the prevalence of resistant strains).
Use during pregnancy and lactation
Contraindicated in pregnancy and lactation.
Dosage and administration
Tablets are designed to be taken orally, the interval between taking each of the single doses - 12 hours. It is recommended to adhere as precisely as possible to the specified interval between doses (this allows you to maintain therapeutic levels of antibacterial substances in the body). Dosing is individual (pathogenic flora, severity and dynamics of the disease, as well as age, weight and renal excretory function should be considered). The average recommended single dose (single dose is taken twice a day): - Persons over 12 years old - 2 pills. - Patients 6-12 years old - 1 tablet. - for patients from 6 months to 5 years - 1/2 tablet. - Patients from 2 months to 6 months - 1/4 pill. The average duration of antibacterial therapy with Co-trimoxazole is 5-7 days.Do not interrupt the course of antibiotic treatment, even in case of disappearance of clinical signs of the disease. If you need more prolonged therapy (up to 14 days), adults, starting from day 7 of therapy, are recommended to take 50% of the average dose. In the case of the acute form of brucellosis, the duration of administration of antibacterial agents should be 3-4 weeks, with paratyphoid fever and typhus - 1-3 months. Special cases of dosing: - Chronic forms of infectious diseases of the urinary system (as prophylaxis) - adults 1 tablet at night, children under 12 years old 12 mg / kg of body weight per day at night (the dose is based on sulfamethoxazole). Duration of prevention up to 12 months. - In case of cystitis, patients of 7–16 years old are prescribed 1 tablet every 12 hours for 3 days (6 single doses in total). - When gonorrhea is prescribed 4-6 pills, which are divided into 3 doses with breaks of 12 hours. - In pneumonia associated with Pneumocystis carinii, 15–20 mg / kg of weight of trimethoprim and 120 mg / kg of weight of sulfamethoxazole per day are prescribed. The daily dose is divided into 4 doses (with intervals of 6 hours). The course is 14 days. The functional activity of the kidneys, liver and hematopoietic system should be monitored if the treatment time is more than 14 days in a row. At purpose of high (shock) doses plentiful drink is required (for the prevention of a crystalluria). Ultraviolet radiation can provoke the development of undesirable reactions (photosensitivity) during therapy. The patient should exclude sunbathing and tanning beds for the period of treatment.
The adverse effects that were recorded during the study of the drug Co-trimoxazole are sorted according to the body systems: - Blood formation: leukopenia, thrombocytopenia, anemia, hemolytic and aplastic, eosinophilia, agranulocytosis. - Urinary system: toxic form of nephropathy, interstitial nephritis, crystalluria (mainly with shock doses), kidney function deficiency. - Allergic reactions: polymorphic erythema, urticaria, itching and skin rash, Lyell's syndrome, allergic myocarditis, Stevens-Johnson syndrome.- Other adverse effects that were recorded in patients: peripheral neuritis, pulmonary infiltration, headache, hyperkalemia, hyponatremia, weakness, hyperthermia, pain in the joints and muscles, photosensitivity reactions. Immediate withdrawal of the drug is required for the development of cough, rash and pain in the joints, as well as other pronounced side effects.
The adverse effects that were recorded during the study of the drug Co-trimoxazole are sorted according to the body systems: - Blood formation: leukopenia, thrombocytopenia, anemia, hemolytic and aplastic, eosinophilia, agranulocytosis. - Urinary system: toxic form of nephropathy, interstitial nephritis, crystalluria (mainly with shock doses), kidney function deficiency. - Allergic reactions: polymorphic erythema, urticaria, itching and skin rash, Lyell's syndrome, allergic myocarditis, Stevens-Johnson syndrome. - Other adverse effects that were recorded in patients: peripheral neuritis, pulmonary infiltration, headache, hyperkalemia, hyponatremia, weakness, hyperthermia, pain in the joints and muscles, photosensitivity reactions. Immediate withdrawal of the drug is required for the development of cough, rash and pain in the joints, as well as other pronounced side effects.