Alternate Name(s):
Cotrimoxazole, Septra
Classification:
Antibiotic
Original Date:
January 2009
Revised Date:
January 2018
Indications:
- Treatment of infections caused by Stenotrophomonas maltophilia, unresponsive to other therapies.
Administration:
- IV intermittent infusion: over 60 minutes
- PO
Dosage:
Dosage recommendations are based on the trimethoprim component
IV/PO:
- 15 - 20 mg/kg/day divided Q6-8h
Dosage adjustment required in renal impairment. Refer to available references or clinical pharmacist for dosage adjustment
Side Effects:
- Dermatologic: skin rash, Stevens-Johnson (rare)
- Endocrine and metabolic: hyperkalemia, hypoglycemia (rare), hyponatremia
- GI: nausea and vomiting
- Hematologic: anemia, eosinophilia, leukopenia, neutropenia, thrombocytopenia
- Hepatic: cholestatic jaundice, hyperbilirubinemia, increased transaminases
- Local: irritation, pain, phlebitis
- Renal: increased blood urea nitrogen, increased serum creatinine
Parameters to Monitor:
- CBC
- Electrolytes
- BUN, creatinine
- Bilirubin
Reconstitution and Stability:
- Sulfamethoxazole 80 mg/mL and Trimethoprim 16 mg/mL
- Take 2.5 mL (40 mg of Trimethoprim) and add to 47.5 mL of D5W
- Final concentration: 0.8 mg/mL of Trimethoprim
Compatibility:
- Solutions Compatible: D5W
- Incompatible: dobutamine, fentanyl, midazolam, 0.9% NaCL
- Uncertain: TPN
-Variable compatibility periods have been reported for sulfamethoxazole-trimethoprim mixed in solutions. Precipitation of trimethoprim occurs irregularly in varying time periods depending on the concentration, with more rapid precipitation being possible at higher concentrations. The specific solution may also influence the precipitation. For all mixtures involving sulfamethoxazole-trimethoprim, including Y-site administration, careful inspection and close monitoring for precipitation is warranted.
Notes:
- Avoid in infants < 1 month of age
- Contains benzyl alcohol
References:
- Lexicomp (Lexi-Drugs), Drug Information Handbook 23rd Ed. Hudson, Ohio, Lexi-Comp, Inc. 2014-2015
- Chen.J, Lau.E (Editors), Drug handbook and Formulary - The Hospital for Sick Children. Toronto; 2017
- Ryan KL, Dersch-Mills D, Clark D. Trimethoprim-Sulfamethoxazole for Treatment of Stenotrophomonas maltophilia Pneumonia in a Neonate. Can J Hosp Pharm. 2013 Nov;66(6):384-7.