Cotrimoxazole is an oldest cheaper medicine. Trimethoprim and sulfamethoxazole is it’s combination uses for bacterial infections. Cotrimoxazole Uses Side effects (Trimethoprim+sulfamethoxazole) in detail
Cotrimoxazole Brand Names:
It is also available by it’s generic name cotrimoxazole. Some brands available in the market are as given below:
Colizole DS tablet
Bactrim ds tablet
ORIPRIM, COPRIME, COTRIBID, LARPRIM, SEPTRAN, BACTRIM, COSULF, NEOPRIM SUSP, WYPAL, VOSTRIM,PENETRIN, ALCORIM-F, NEOPRIM SUSP, LARPRIM, COLIZOLE, KOMBINA, ANTRIMA, SEPMAX, SEPTABID,OTRIM, TABROL, CO-TRIMOXAZOLE, METHOXAPRIM,COTRIMOXAZOLE DS, ALCORIM-F, COSULF, COPRIME, CHEMOTRIN FORTE, TRISULFOSE, SYNERTAB, WELPRIM, SEPTINIX, COTRIMOXAZOLE (GENO), COTRIMOX, ALCORIM-F, COSULF, ORIPRIM
Besides these others brands are also available in the market.
Introduction of cotrimoxazole:
Cotrimoxazole is fixed dose combination of trimethoprim and sulfamethoxazole. Trimethoprim may be a diaminopyrimidine associated with the antimalarial pyrimethamine. Which selectively inhibits bacterial dihydrofolate reductase (DHFRase). Cotrimoxazole introduced in 1969 causes sequential block of folate metabolism. Human folate metabolism isn’t interfered at antibacterial concentrations of trimethoprim.
Individually, both sulfonamide and trimethoprim are bacteriostatic. but the mixture becomes Acidal against many organisms. when the organism is sensitive to both the components then maximum synergism seen. but even when it’s moderately immune to one component, the action of the opposite also enhanced. Sulfamethoxazole and trimethoprim combined together having same t½ (~ 10 hr). Optimal synergy just in case of most organisms is exhibited at a degree ratio of sulfamethoxazole 20 : trimethoprim 1. The MIC of every component could also reduced by 3-6 times. This ratio obtained within the plasma. When the 2 are given during a dose ratio of 5:1.
However, the concentration ratio in many tissues is a smaller amount than 20 : 1. Trimethoprim adequately crosses barrier and placenta. while sulfamethoxazole features a poorer entry. Moreover, trimethoprim is sooner absorbed than sulfamethoxazole concentration ratios may vary with time. Trimethoprim is 40% plasma protein bound. while sulfamethoxazole is 65% bound. Resistance Bacteria are capable of acquiring resistance to trimethoprim through plasmid mediated acquisition of a DHFRase having lower affinity for the inhibitor. Resistance to the mixture has slow to develop compared to either drug alone. but widespread use of the mixture over an extended period resulted in reduced responsiveness of over 30% originally sensitive strains.
Trimethoprim Sulfamethoxazole 80 mg + 400 mg tab: 2 times in a day for two days then 1 BD.
160 mg + 800 mg tab: double strength (DS); 1 BD.
20 mg + 100 mg pediatric tab. 40 mg + 200 mg per 5 ml susp; infant 2.5 ml (not to be utilized in newborns), children 1-5 yr 5 ml, 6-12 year 10 ml (all BD).
160 mg + 800 mg per 3 ml for i.m. injection 12 hourly. (CIPLIN, ORIPRIM-IM) 80 mg + 400 mg per 5 ml for i.v. injection
(WK-TRIM, ORIPRIM-IV) 10-15 ml BD.
Cotrimazine a mixture of trimethoprim with sulfadiazine. Its utility is analogous thereto of cotrimoxazole. Trimethoprim Sulfadiazine 90 mg + 410 mg: AUBRIL tab, 2 tab BD for 2 days, then 1 BD. 180 mg + 820 mg: TRIGLOBE FORTE tab.
Though cotrimoxazole remains used. its popularity in the treatment of systemic infections declined. Common indications are: Most acute uncomplicated infections respond rapidly. Single dose therapy with 4 tablets of cotrimoxazole used successfully for acute cystitis. Courses of 3-10 days advised for lower and upper tract infections, according to associated features.
●Cotrimoxazole is specially valuable for chronic or recurrent cases or in prostatitis. because trimethoprim is concentrated in prostate.
● tract infections : Both upper and lower tract infections, including chronic bronchitis and facio-maxillary infections, otitis. Which caused by gram positive cocci and H. influenzae respond well.
● Bacterial diarrhoeas and dysentery:
Cotriomoxazole could also used for severe and invasive infections by E. coli, Shigella, nontyphoid Salmonella, and Y. enterocolitica. Though response rate is less previously fluoroquinolones are more commonly used.
● Pneumocystis jiroveci causes severe pneumonia in neutropenic and AIDS patients. Cotrimoxazole has prophylactic also as therapeutic value but high doses are needed. One DS tablet 4-6 times/day for 2-3 weeks could also be curative. but adverse effects necessitate discontinuation in upto 20% cases. One DS tab. daily has been used for prophylaxis and thi5. Chancroid. Cotrimoxazole (800 + 160 mg) BD for 14 days may be a 3rd choice, but less expensive, alternative to ceftriaxone, azithromycin or ciprofloxacin.
● Typhoid Initially cotrimoxazole was an efficient alternative to chloramphenicol. However, it’s become unreliable, and is seldom used now.
● Cotrimoxazole is an alternate to penicillin for protecting agranulocytosis patients. and for treating respiratory or other infections in them.
Cotrimoxazole Adverse effects (sideeffect):
All adverse effects seen with sulfonamides are often produced by cotrimoxazole.
• Nausea, vomiting, stomatitis, headache and rashes sideeffect seen.
• Blood dyscrasias occur rarely. Cotrimoxazole shouldn’t tend during pregnancy.
Neonatal haemolysis and methaemoglobinaemia can occur if it’s given near term.
Patients with renal disease may develop uremia. Reduce dose in moderately severe renal impairment.
A high incidence (upto 50%) of fever, rash and bone marrow hypoplasia reported among AIDS patients with Pneumocystis jiroveci infection. when treated with high dose cotrimoxazole.
The elder people have greater risk of bone marrow toxicity.
Diuretics given with cotrimoxazole produced a better incidence of thrombocytopeni.