OralEar, nose and/or throat infections, Gastrointestinal infections, Genital infections, Respiratory tract infections, Skin infections, Susceptible infections, Urinary tract infectionsAdult: Each tablet contains sulfamoxole 400 mg and trimethoprim 60 mg: Initially, 2 tablets, followed by 1 tablet bid. Each 5 ml contains sulfamoxole 200 mg and trimethoprim 40 mg: Initially, 20 ml, followed by 10 ml bid.
Child: Each 5 ml contains sulfamoxole 200 mg and trimethoprim 40 mg: 4-12 mth: Initially, 2.5-5 ml followed by 1.2-2.5 ml bid; 1-6 yr: Initially, 5-10 ml, followed by 2.5-5 ml bid, 6-12 yr: Initially, 10-15 ml, followed by 5-10 ml bid.
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Dose reduction is advisable.
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Hypersensitivity to sulfonamides; severe renal or hepatic impairment; porphyria, SLE; serious haematological disorders; megaloblastic anemia secondary to folate depletion. Infants <2 mth; pregnancy (3rd trimester), lactation.
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Renal insufficiency, elderly, blood dyscrasias, G6PD deficiency, AIDS, patient with potential folate deficiency, children with fragile X chromosome associated with mental retardation. Perform regular haematological examination.
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Nausea, vomiting, anorexia, diarrhoea, glossitis, stomatitis, drowsiness, headache, depression, hallucinations, hypersensitivity skin reaction, photosensitivity, drug fever, crystalluria, elevation of liver enzymes, hypothyroidism, hyponatremia, hyperkalemia, kernicterus in premature neonates, aseptic meningitis, cholestatic jaundice.
Potentially Fatal: Anaphylaxis; Stevens-Johnson syndrome; blood dyscrasias e.g. agranulocytosis, aplastic anaemia; toxic epidermal necrolysis.
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Nausea, vomiting, allergic reactions. If within 3 hrs of ingestion, gastric lavage to be performed, followed by IM folinic acid, vitamin B12 and supportive treatment. Perform LFT once a wk and FBC twice a wk for 3 wks.
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Concurrent use increases risk of blood dyscrasias with azathioprine, methotrexate, pyrimethamine; increased risk of hyperkalaemia with ACE inhibitors; increased risk of hyponatraemia when used with both potassium-sparing diuretics and thiazides; increases risk of bleeding with warfarin; increases risk of lithium toxicity; increases digoxin, phenytoin, procainamide, lamivudine, stavudine, repaglinide, rosiglitazone, dofetilide serum levels; decreases ciclosporin levels. Concurrent use with dapsone increases serum levels of both and increases risk of dapsone toxicity. Concurrent may potentiate antidiabetic effect of sulphonylureas.
Potentially Fatal: Concurrent use increases risk of blood dyscrasias with clozapine and pyrimethamine.
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Interference with tests for urea, creatinine, urinary glucose, urobilinogen, serum methotrexate ( when dihydrofolate reductase is used) and creatinine assay (when Jaffe reaction is used).
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Description:
Mechanism of Action: Sulfamoxole interferes with nucleic acid synthesis in microorganisms by blocking the conversion of p-aminobenzoic acid to the coenzyme dihydrofolic acid. Trimethoprim inhibits the conversion of bacterial dihydrofolic acid to tetrahydrofolic acid which is important for the synthesis of DNA.
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