Description
Co-Trimoxazole Pharmacodynamics
Combined bactericidal chemotherapeutic agent
The drug Co-trimoxazole contains two active substances, which have a synergistic effect by blocking two enzymes that catalyze the successive stages of folinic acid biosynthesis in microorganisms. Due to this mechanism, the bactericidal action in vitro is achieved at concentrations where the individual components of the drug have only a bacteriostatic effect. In addition, the drug Co-trimoxazole is often effective against pathogens resistant to one of its components.
In vitro antibacterial action of Co-Trimoxazole covers a wide range of Gram-positive and Gram-negative pathogens, although sensitivity may depend on the geographical location.
Indications
Co-trimoxazole should be prescribed only when, in the opinion of the physician, the benefits of such therapy outweigh the possible risks; it should be decided whether a single effective antibacterial agent can be used alone, and the recommendations of official guidelines for the appropriate use of antibacterial agents and the local prevalence of antibacterial resistance should be considered.
Because bacterial sensitivity to in vitro antibiotics varies in different geographic areas and over time, local bacterial sensitivity should be considered when selecting a drug. Co-trimoxazole should be used only for therapy or prophylaxis of infections that are known or likely to be caused by bacteria or other microorganisms sensitive to the drug. In the absence of such information, appropriate antibiotic therapy should be chosen empirically according to the epidemiological situation and local characteristics of bacterial sensitivity.
Respiratory and ENT-organ infections: exacerbation of chronic bronchitis, otitis media in children. Treatment and prevention (primary and secondary) of pneumonia caused by Pneumocystis jirovecii in adults and children, including those with severe immunodeficiency.
Infections of the genitourinary tract: urinary tract infections, soft chancres. Gastrointestinal tract infections: typhoid and paratyphoid, shigellosis (caused by susceptible strains of Shigella flexneri and Shigella sonnei, if antibiotic therapy is indicated), travelers’ diarrhea caused by enteropathogenic strains of Escherichia coli, cholera (in addition to fluid and electrolyte supplementation).
Other infections: infections caused by a variety of microorganisms (may be combined with other antibiotics), such as: brucellosis, acute and chronic osteomyelitis, nocardiosis, actinomycosis, toxoplasmosis and South American blastomycosis.
Contraindications
Hypersensitivity to co-trimoxazole (sulfamethoxazole + trimethoprim) and other components of the drug in anamnesis; marked damage of liver parenchyma; severe renal insufficiency (creatinine clearance <15 ml/min); peritoneal dialysis; blood diseases (aplastic anemia, B12-deficiency anemia, agranulocytosis, leukopenia, megaloblastic anemia due to folic acid deficiency); in combination with docetilide, paclitaxel and amiodarone; childhood age less than 6 weeks; glucose-6-phosphate dehydrogenase deficiency; III trimester of pregnancy; fructose intolerance.
Concomitant use with clozapine should be avoided since the latter is known to cause agranulocytosis.
Dosage and administration
- Inside, after a meal with plenty of liquid.
- Shaken before use until a homogeneous suspension.
- For easy dosing, use the measuring spoon or measuring syringe, enclosed in the package.
5 ml of suspension corresponds to 200 mg of sulfamethoxazole and 40 mg of trimethoprim. - Standard dosage
Adults and children over 12 years of age at 12-hour intervals:
Oral suspension. - morning evening
Standard dose 20 ml 20 ml
Minimum dose and extended treatment (more than 14 days) 10 ml 10 ml
Increased dose (in particularly severe cases) 30 ml 30 ml - Duration of treatment
In acute infections, Co-trimoxazole should be prescribed for at least 5 days or until the patient is symptom-free for 2 days. If there is no clinical improvement after 7 days of therapy, the patient should be re-evaluated for possible treatment correction.
