Cotrimoxazole 800/160

Rx

Indications:

Acute otitis media, chronic or recurrent urinary tract infections (UTIs) or prostatitis, respiratory tract infections, gastrointestinal infections, brucellosis, cholera, plague, Pneumocystis jiroveci (Pneumocystis carinii) pneumonia, toxoplasmosis.

Dosage:

Dosage of cotrimoxazole is expressed in terms of the trimethoprim content.

Acute otitis media in children 2 months of age or older: 8 mg/kg daily, in 2 divided doses every 12 hours, in 10 days.

Chronic or recurrent urinary tract infections (UTIs) or prostatitis in adults: 1 tablet, twice daily x 10 – 14 days (chronic or recurrent UTIs) or x 3 – 6 months (prostatitis).

Prevention of chronic or recurrent UTIs:

• Adults: 40 – 80 mg daily or 3 times a week, in 3 – 6 months;
• Children 2 months of age or older: 8 mg/kg daily in 2 divided doses.

Respiratory tract infections in adults: 1 tablet, twice daily in 14 days.

Gastrointestinal infections by Shigella:

• Adults: 1 tablet, twice daily.
• Children: 8 mg/kg daily in 2 divided doses, in 5 days.

Brucellosis in children: 10 mg/kg daily (maximum 480 mg daily) in 2 divided doses, in 4 – 6 weeks.

Cholera:

• Adults: 1 tablet, twice daily in 3 days
• Children: 4 – 5 mg/kg x twice daily in 3 days, in conjunction with fluid and electrolyte replacement.

Prevention of plague:

• Adults: 2 – 4 tablets daily in 2 divided doses, in 7 days;
• Children 2 months of age or older: 8 mg/kg daily in 2 divided doses, in 7 days.

Pneumocystis jiroveci (Pneumocystis carinii) pneumonia (PCP):

• Treatment in adults and children 2 months of age or older: 15 – 20 mg/kg daily in 3-4 divided doses, in 14 – 21 days.
• Primary and secondary prevention: HIV infected adults and adolescents: 1 tablet, once daily; children, including HIV-infected: 150 mg/m² in 2 divided doses, 3 consecutive days each week.

Primary prophylaxis of toxoplasmosis:

• Adults and adolescents: ½ – 1 tablet once daily.
• HIV-infected children: 150 mg/m² daily, in 2 divided doses.

Renal impairment: Clcr < 15 ml/min (not recommend); Clcr: 15 – 30 ml/min (½ the usual regimen).

Usage:

Cotrimoxazole 800/160 is administered orally with some food or drink.

• Known hypersensitivity to any of the active substances or excipients.
• Patients with marked hepatic damage, severe renal impairment.
• Patients with documented megaloblastic anemia to folate deficiency.
• Pregnancy and lactation.
• Infants younger than 2 months of age.

Nausea, vomiting, anorexia and diarrhea. Fever, reactions involving the skin may include rashes, pruritus, photosensitivity reactions, exfoliative dermatitis and erythema. Potentially fatal, skin reactions including toxic epidermal necrolysis and the Stevens-Johnson syndrome. Interstitial nephritis and tubular necrosis, lumbar pain, haematuria, oliguria, anuria.

• Should not use for pharyngitis caused by Pyogenes.
• Patients with impaired renal function, elderly, chronic alcoholics, receiving anticonvulsants, malnourished patients, malabsorption syndrome, severe allergy or bronchial asthma, or with glucose-6-phosphate-dehydrogenase deficiency.
• Patients should be cautioned maintain adequate fluid intake to prevent stone formation.
• Regular blood counts and urinalyses and renal-function tests should be carried out in patients receiving prolonged treatment.
• Patients should be aware of how they react to Cotrimoxazole 800/160 before driving or operating machinery.