Cotrimoxazole

Cotrimoxazole (cotrimoxazole) is useful for treating diseases caused by bacterial infections, such as bronchitis, middle ear infections ( otitis media ) , and urinary tract infections. Cotrimoxazole is a combination drug consisting of trimethoprim and sulfamethoxazole.

Cotrimoxazole can also be used to treat and prevent the occurrence of pneumocystis pneumonia (PCP), which is a lung infection caused by the fungus Pneumocystis jirovecii . This infection usually occurs in people with a weak immune system, such as HIV/AIDS patients.

Cotrimoxazole belongs to the category of sulfonamide antibiotics . This drug works by stopping the growth of bacteria, thus helping the body's immune system to kill the bacteria to the point of exhaustion. It should be remembered that cotrimoxazole cannot cure diseases caused by viral infections, such as colds and flu.

Cotrimoxazole trademarks : Cotrimoxazole, Decatrim, Infatrim, Infatrim Forte, Mesaprim, Miratrim, Miratrim Forte, Mesaprim, Moxalas, Novatrimm Omegtrim, Primavon, Ratrim Forte, Sanprima, Saltrim, Sanprima Forte, Sisoprim, Sisoprim Forte, Sultrimmix, Trimoxsul Forte, Toxaprim , Ekaprim Forte

What is Cotrimoxazole?

Warnings Before Consuming Cotrimoxazole

Cotrimoxazole should not be used indiscriminately. Consider the following before consuming this medicine:

• Do not take cotrimoxazole if you are allergic to sulfamethoxazole or trimethoprim.
• Tell your doctor if you have ever suffered from thrombocytopenia as a result of taking sulfonamides or trimethoprim.
• Tell your doctor if you have megaloblastic anemia due to folate deficiency, phenylketonuria , liver disease, or kidney disease . Patients with the condition may not be able to consume cotrimoxazole.
• Tell your doctor if you have had or are suffering from asthma, folic acid deficiency, HIV/AIDS , thyroid disease, porphyria , or G6PD deficiency .
• Tell your doctor if you are taking certain drugs, supplements, or herbal products, to anticipate possible drug interactions.
• Avoid exposure to direct sunlight for a long period of time during treatment with cotrimoxazole, because this drug can cause the skin to become more sensitive. Use clothes that cover the body, sunscreen , and sunglasses, when going outdoors.
• Tell your doctor if you are pregnant, breastfeeding, or planning to become pregnant, because this medicine is suspected to cause birth defects.
• See a doctor immediately if an allergic drug reaction or a very serious side effect occurs after consuming cotrimoxazole.

Dosage and Administration of Cotrimoxazole

There are oral cotrimoxazole preparations in the form of tablets, caplets, or suspensions. Cotrimoxazole tablets or caplets contain 800 mg of sulfamethoxazole and 160 mg of trimethoprim (960 mg); or 400 mg of sulfamethoxazole and 80 mg of trimethoprim (480 mg);

Cotrimoxazole suspension contains 400 mg of sulfamethoxazole and 80 mg of trimethoprim (480 mg) per 5 ml of suspension; or 200 mg of sulfamethoxazole and 40 mg of trimethoprim (240 mg) per 5 ml of suspension.

The dose of cotrimoxazole given by the doctor depends on the purpose of the treatment and the age of the patient. Here is the explanation:

Purpose: Treat exacerbation of chronic bronchitis , urinary tract infection, acute otitis media

Adults and children aged >12 years

• Dose for infection 960 mg, 2 times a day. The dose for severe infections is 2,880 mg per day divided into 2 consumption schedules.

Children aged 6–1 2 years

• 480 mg, 2 times a day.

Children aged 6 months to 5 years

• 240 mg, 2 times a day.

Children aged 6 weeks - 5 months

• 120 mg, 2 times a day.

Purpose : Treat pneumocystis pneumonia

Adults and children aged >12 years :

• Dose up to 120 mg/kg body weight (BB), divided into 2-4 consumption schedules. The duration of treatment is 14–21 days.

Purpose : Prevent pneumocystis pneumonia

Adults

• 960 mg, 1 time a day, for 7 days.
• First alternative dose: 960 mg, 1 time a day, consumed 3 times a week.
• Second alternative dose: 960 mg, 2 times a day, consumed 3 times a week.

A wants to be >12 years old

• 960 mg, 2 times a day, for 7 days.
• First alternative dose: 960 mg, 2 times a day, consumed for 3 consecutive days.
• Second alternative dose: 1,920 mg, 1 time a day, consumed for 3 consecutive days.

Children aged 6–12 years

• 480 mg, 2 times a day, for 7 days.
• First alternative dose: 480 mg, 2 times a day, consumed for 3 consecutive days or alternately (1 day of medication followed by 1 day of no medication).
• Second alternative dose: 960 mg, 1 time a day, consumed for 3 consecutive days.

Children aged 6 months to 5 years

• 240 mg, 2 times a day, for 7 days.
• First alternative dose: 240 mg 2 times a day, consumed for 3 consecutive days or alternately (1 day of medication followed by 1 day of no medication).
• Second alternative dose: 480 mg, 1 time a day, consumed for 3 consecutive days.

Children aged 6 weeks–5 months

• 120 mg, 2 times a day, for 7 days.
• The first alternative dose: 120 mg, consumed for 3 consecutive days in a week or alternately (1 day of medication followed by 1 day of no medication).
• Second alternative dose: 240 mg, 1 time a day, consumed for 3 consecutive days.

How to Consume Cotrimoxazole Correctly

Follow the doctor 's advice and read the instructions on the cotrimoxazole package before starting to consume it. Do not increase or decrease the dose consumed without first consulting a doctor.

To reduce the possibility of stomach pain, cotrimoxazole should be consumed with a meal. Try to consume this medicine at the same time every day.

During treatment with this drug, it is recommended to drink more water because it can help prevent the risk of side effects of the drug. You can also consume cotrimoxazole with a glass of water.

When you consume cotrimoxazole suspension, make sure to shake the medicine first. Use the available measuring spoon or other measuring device to ensure that the dose consumed is accurate. Do not use a regular tablespoon to measure the medicine.

If you forget to take cotrimoxazole, take this medicine immediately if the interval with the next consumption schedule is not too close. When it is close, ignore the dose and do not double the next dose.

If in the middle of the treatment you already feel that there are no complaints, continue to consume cotrimoxazole until the time recommended by the doctor. Stopping treatment early can increase the risk of recurrence of bacterial infections that are more difficult to overcome.

Store cotrimoxazole in a closed container in a dry and cool place. Avoid exposure to sunlight and keep out of the reach of children.

Interactions of Cotrimoxazole with Other Drugs

There are several interactions that can occur if cotrimoxazole is used with certain drugs, among others:

• Increased risk of thrombocytopenia, which may be marked by the presence of purple-red spots on the skin (purpura), if used with thiazides, especially in the elderly
• Increased risk of side effects from sulfonylurea diabetes drugs , phenytoin, or oral anticoagulants , such as warfarin
• Increased risk of kidney damage if used with ciclosporin
• Increased risk of megaloblastic anemia if used with methotrexate or folate inhibitors such as pyrimethamine
• Increased rates from digoxin, lamivudine , procainamide, or repaglinide, zidovudine
• Increased risk of hyperkalemia if used with ACE inhibitor drugs
• An increase in the level of dofetilide in the blood that can cause prolongation of the QT interval of the heart, including tor sades de pointes which can have fatal consequences
• Increased risk of treatment failure if used with leucovorin in HIV patients with P. jirovecii pneumonia 

Side Effects and Dangers of Cotrimoxazole

Side effects that may occur after consuming cotrimoxazole are:

• Nausea and vomiting
• Diarrhea
• Loss of appetite

Consult a doctor if the complaint does not subside or worsens. This drug can also increase the risk of candidiasis in the mouth or vagina if used in the long term.

Contact your doctor immediately if you experience serious side effects, such as:

• Muscles feel weak
• Unusual mood swings
• Kidney disorders, which can be marked by changes in the amount of urine or bloody urine ( hematuria )
• Heavy sleepiness that interferes with daily activities
• Lack of sugar in the blood ( hypoglycemia ), which can be marked by shaking, fast heart rate, hunger, and cold sweats
• Diarrhea more than 3 times a day, which is accompanied by abdominal cramps, as well as blood and mucus in the stool

Get medical help immediately if you experience a serious drug allergic reaction or side effect, such as:

• Headache that does not improve, neck stiffness, slow ( bradycardia ) or irregular heartbeat, or seizures
• Fever, cough, or sore throat that does not improve
• Nausea or vomiting that does not subside
• New or worsening swelling of the lymph nodes
• Pale skin
• Joint pain
• Difficulty breathing
• The body bruises or bleeds easily
• Jaundice , feeling very tired, or dark colored urine