Alternate Name(s):
BACTRIM; COTRIMOXAZOLE; SEPTRA
Classification:
Antibiotic
Original Date:
August 2005
Revised Date:
November 2017
Indications:
- Treatment of infections due to susceptible gram positive and gram negative bacteria
- Treatment of Pneumocystis carinii pneumonia (PCP).
Reconstitution and Stability:
- Available as ampoules containing 16 mg/mL Trimethoprim and 80 mg/mL sulfamethoxazole
- All doses, dilutions based on the trimethoprim [TMP] component
- Protect from light. Keep at room temperature, do not refrigerate
- MUST be diluted prior to use
- Diluted with D5W to a concentration of 0.64 mg/mL of TMP stable 48 hrs
- Diluted with D5W to a concentration of 0.8 mg/mL of TMP stable 24 hrs
- Diluted with D5W to a concentration of 1 mg/mL of TMP stable 2 hours
- Diluted with D5W to a concentration of 1.6 mg/mL of TMP stable 1 hour
Compatibility:
- Solutions Compatible: D5W
- Additives/Above Cassette Compatible: no information
- Y-site Compatible: morphine
- Incompatible: TPN, 0.9% NaCl (compatible with 0.9% NaCl) but over time, a precipitate forms. Therefore, D5W is the preferred solution)
Administration:
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct |
NO |
| IV Intermittent Infusion | YES
Syringe pump dilution: 0.8 mg/mL of TMP ONLY
Large volume pump Usual dilution: 0.64 to 0.8 mg/mL of TMP preferred dilution Infusion time: 1 to 1.5 hours |
| IV Continuous Infusion | NO |
Dosage:
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
- Based on Trimethoprim [TMP] component
Adult/Pediatric:
- Bacterial Infection: 8-12 mg TMP/kg/day IV ÷ Q 12 hours
- Pneumocystis carnii: 20 mg TMP/kg/day IV ÷ Q 6 hours
- Pneumocystitis carinii prophylaxis: 150 mg TMP/m2/day IV÷ Q 12-24 hours 3 days/week
- CF Dosing:
- 12 mg TMP/kg/day IV ÷ Q 12 hours
- Severe infections: 15-20 mg/kg/day ÷ Q 6 hours
Adjustment for Renal Impairment:
- CrCl > 30 mL/minute: Standard regimen
- CrCl 15-30 mL/minute: Reduce dose by 50%
- CrCl < 15 mL/minute: Not recommended
Potential hazards of parenteral administration:
- Thrombophlebitis, pain and local irritation at site of injection
- Rare fatalities have occurred due to severe Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatic necrosis, agranulocytosis, aplastic anemia and other blood dyscrasias; discontinue use at first sign of rash or any sign of adverse reaction
- Nausea, vomiting
- Mild and reversible increase in serum creatinine
- Hyperkalemia
Notes:
- Avoid in infants <2 months of age
- Allergy - avoid in patients with known hypersensitivity to trimethoprim or sulfonamides
- Avoid in patients with megaloblastic anemia due to folate deficiency
- Fluid overload is a possible complication of large doses of cotrimoxazole
- Use with caution in G-6-PD deficiency, impaired renal or hepatic function
- Monitor blood counts in patients predisposed to folate deficiency (malnutrition states, malabsorption syndromes and anticonvulsant therapy)
- May potentiate the effects of oral anticoagulants (e.g. Warfarin)
- Decreases serum cyclosporin levels
- Injection contains propylene glycol 40%, ethanol 10%, benzyl alcohol 1%, diethanolamine 0.3% and sodium metabisulfite 0.1%
- Maintain adequate fluid intake to prevent crystalluria and stone formation
- Increases the effect of phenytoin, digoxin and thiopental