Neonatal Drug Therapy Manual

Sulfamethoxazole/Trimethoprim

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

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

- Y-site Compatible: morphine

- Incompatible: dobutamine, fentanyl, midazolam, TPN

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

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