COTRIMOXAZOLE

Antibacterial containing trimethoprim and sulphamethoxazole

Dosage Forms

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Tablet

400 mg sulphamethoxazole + 80 mg trimethoprim
100 mg sulphamethoxazole + 20 mg trimethoprim

IV Infusion

96 mg/ml

Uses

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  • Brucellosis
  • Typhoid fever
  • Ear, nose, and throat infections
  • Tropical ulcer
  • Acute urinary tract infection
  • Prophylaxis against opportunistic bacterial and protozoal infections in HIV patients

Dose and Duration

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The infusion must be diluted immediately before use. It should only be used in patients unable to take oral therapy
Brucellosis (in combination with gentamicin)
Adult:480 mg every 12 hours for 6 weeks
Typhoid fever
Adult:960 mg every 12 hours for 14 days
Child:24 mg/kg every 12 hours for 14 days
Ear, nose, and throat infection, tropical ulcer
Adult: 960 mg every 12 hours for 5 days
Child:24 mg/kg every 12 hours for 5 days
Acute urinary tract infection
Adult: 960 mg every 12 hours for 5 days
Child:24 mg/kg every 12 hours for 5 days
Patients unable to take oral cotrimoxazole
Adult:by IV infusion, 960 mg every 12 hours increased to 1.44 g every 12 hours in severe infections
Child:by IV infusion, 18 mg/kg every 12 hours increased to 27 mg/kg every 12 hours in severe infections
Prophylaxis against opportunistic bacterial infections in HIV infection
Adult:960 mg once daily
Child: 24 mg/kg once daily

Preparation

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  • Can be diluted with 5% or 10% dextrose, dextran 70 or 0.9% sodium chloride solution
  • 5 ml of cotrimoxazole should be added to 125 ml, 10 ml to 250 ml and 15 ml to 500 ml of infusion solution

Contraindications

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  • Allergy to sulphonamides or trimethoprim
  • Children <1 month
  • Hypersensitivity to cortisone acetateSevere kidney disease
  • Severe liver disease

Side Effects

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  • Allergic reactions, e.g. skin rash
  • Stevens-Johnson syndrome
  • Candida overgrowth
  • Hyperkalaemia
  • Headache
  • Nausea, diarrhoea, stomach upset

Interactions

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  • Methotrexate (increased risk of methotrexate toxicity)
  • Phenytoin (increased side effects)
  • Sulfadoxine + pyrimethamine (increased side effects)
  • Folic acid (cancelled effect)

Patient Instructions

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  • Stop treatment and report to health worker immediately if any skin rash occurs
  • Drink plenty of fluids during treatment

Pregnancy

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  • Do not use in 1st and 3rd trimester
  • Can be used for prophylaxis in HIV patients as benefits outweigh risks

Breastfeeding

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  • Can be used

⚠️ Caution

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  • Cotrimoxazole is not effective for the treatment of sore throat and should not be used
  • If patient gets severe skin rash or Stevens-Johnson syndrome, stop medicine immediately