How Long After Taking Sulfamethoxazole Can I Drink Alcohol?

Nitroimidazoles – Metronidazole is a nitroimidazole antibiotic that doctors prescribe to treat abdominal infections, sexually transmitted infections, and other anaerobic bacteria-related infections. Metronidazole affects the function of a key enzyme that helps the body digest alcohol.

abdominal crampingnauseavomitingheadachesfacial flushing

People should avoid drinking alcohol during treatment and up to 3 days after the last dose. Despite this interaction, not everyone will experience these reactions when drinking while taking metronidazole. Still, people should avoid drinking alcohol while taking metronidazole.

Can I drink 12 hours after taking sulfamethoxazole?

No, you should not drink alcohol while taking sulfamethoxazole / trimethoprim tablets, or else you may experience unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting. Drinking any amount of alcohol can result in such side effects,

1. Eep in mind that some cold medicines and mouthwashes also contain alcohol.
2. So check the label and avoid if alcohol is present.
3. The effects of combining antibiotics and alcohol can vary, depending on the specific antibiotic.
4. Alcohol does not diminish the effectiveness of most antibiotics.
5. However, there are certain antibiotics which should not be combined with alcohol because of a drug interaction.

Trimethoprim-sulfamethoxazole is one of these. https://www.drugs.com/interactions-check.php?interaction_list_id=183138729&drug_list=2128-0,1034-14582 https://www.drugs.com/article/antibiotics-alcohol.html

Can I drink alcohol after finishing sulfamethoxazole?

What are the effects of drinking alcohol while taking antibiotics? – Antibiotics and alcohol can cause similar side effects, such as stomach upset, dizziness and drowsiness. Combining antibiotics and alcohol can increase these side effects. A few antibiotics — such as metronidazole (Flagyl), tinidazole (Tindamax), and sulfamethoxazole and trimethoprim (Bactrim) — should not be mixed with alcohol because this may result in a more severe reaction.

• Drinking any amount of alcohol with these medications can result in side effects such as flushing, headache, nausea and vomiting, and rapid heart rate.
• Also, the antibiotic linezolid (Zyvox) interacts with certain alcoholic beverages, including red wine and tap beer.
• Drinking these beverages with this medication can cause a dangerous increase in blood pressure.

Keep in mind that some cold medicines and mouthwashes also contain alcohol. So check the label and avoid such products while taking these antibiotics. Although modest alcohol use doesn’t reduce the effectiveness of most antibiotics, it can reduce your energy and delay how quickly you recover from illness.

How long does it take for sulfamethoxazole to get out of your system?

However, half-life of sulfamethoxazole is 10 hours and trimethoprim is 8 to 10 hours in the blood serum, the drug traces can be found in the urine up to 72 hours of single-dose oral administration.

How many hours should you wait to drink alcohol after taking antibiotics?

What to do – The warning label on your antibiotic should include information about alcohol use. Talk to your doctor or pharmacist if you’re unsure about the details of your medications. They may tell you that an occasional drink is OK. But that likely depends on your age, overall health, and the type of drug you’re taking.

Can I drink coffee while taking sulfamethoxazole?

Tips and advice for taking Bactrim –

Finish all the antibiotics in your prescription, even if you start feeling better. Stopping Bactrim too soon may cause your condition to come back. You can take Bactrim before or after meals. Some people experience side effects such as nausea and vomiting when taking this medication. If you experience these side effects, take Bactrim with meals to reduce them. If you experience diarrhea after taking Bactrim, take probiotic supplements to alleviate this side effect. Continue taking the supplement for a few more days after finishing your last dose of Bactrim. Bactrim (sulfamethoxazole/trimethoprim) makes your skin very sensitive to the sun, so you may burn quickly. This is true even when it’s cool outside and cloudy. Avoid sunlight exposure, wear a wide-brimmed hat, and use sunscreen with an SPF of at least 30 while taking Bactrim. Take Bactrim with 8oz of water and drink plenty of fluids while taking it. Bactrim passes through the kidneys, and insufficient water can cause kidney stones. Avoid drinking too many beverages that dehydrate you, such as coffee and alcoholic drinks. Bactrim may interact with certain medications. Tell your pharmacist about all medicines you take, including over-the-counter drugs, vitamins, and herbal remedies. Bactrim (sulfamethoxazole/trimethoprim) may cause allergic reactions. Sulfonamide antibiotics belong to a class of medications called sulfa drugs. Seek medical care immediately if you experience any signs of an allergic reaction while using Bactrim, such as a rash, hives, or swelling of the face. Tell your providers and pharmacy if you develop an allergy to Bactrim.

Is sulfamethoxazole a powerful antibiotic?

Key points –

Trimethoprim–sulfamethoxazole is an effective antimicrobial, but it has numerous adverse effects, some of which can be severe. Important drug–drug interactions include the development of hyperkalemia with renin-angiotensin system blocking agents or drugs that inhibit kaliuresis, and hypoglycemia with the concomitant use of some hypoglycemic agents. Hyperkalemia in conjunction with use of trimethoprim–sulfamethoxazole can also occur in patients with impaired renal function, diabetes, older age or AIDS. Other toxicities include neurologic, renal and reproductive abnormalities, decreased oxygen-carrying capacity and other hematologic effects, and drug hypersensitivity syndromes.

How do you flush sulfamethoxazole out of your system?

Side effects of Bactrim – Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking Bactrim. Bactrim helps most people with susceptible infections but it may have unwanted side effects in a few people. All medicines can have side effects.

• Nausea, with or without vomiting;
• Diarrhoea or other abdominal (gut) or stomach discomfort.

These side effects are not usually serious or long lasting. Tell your doctor if you notice these side effects and they worry you:

• Oral thrush (white, furry sore tongue and mouth);
• Vaginal thrush (sore itchy vagina with vaginal discharge).

Your doctor will need to treat the thrush infection separately. Tell your doctor immediately if you notice any of the following:

• Jaundice (yellowing of the skin) ;
• Severe or watery diarrhoea;
• Any type of skin rash, peeling of the skin, severe itching or hives;
• Fever, sore throat, lumps in the neck;
• Cough, shortness of breath;
• Severe persistent headache ;
• Discolouration of urine;
• Swelling of the face and throat.

These symptoms are usually rare but may be serious and need urgent medical attention. Very rarely, people have died from complications due to certain severe skin, liver or blood reactions. Elderly people, people with liver or kidney disease and people taking certain other medicines are more at risk of these severe reactions. Other rare side effects include:

• Other allergic reactions;
• Pins and needles in the hands and feet;
• Loss of appetite, fits, headaches, depression, imagined sensations or nervousness;
• Increased or decreased urine production;
• Unsteadiness or dizziness;
• Sleeplessness, weakness, tiredness, increased sensitivity to light and stomach pains.

If you experience any of these effects contact your doctor as soon as possible. This is not a complete list of all possible side effects. Others may occur in some people and there may be some side effects not yet known. Tell your doctor if you notice anything else that is making you feel unwell, even if it is not on this list.

How much water should I drink with sulfamethoxazole?

Proper Use – Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects. Sulfamethoxazole and trimethoprim combination is best taken with a full glass (8 ounces) of water.

1. Several additional glasses of water should be taken every day, unless otherwise directed by your doctor.
2. Drinking extra water will help to prevent some unwanted effects (eg, crystals in the urine).
3. For patients taking the oral liquid, use a specially marked measuring spoon or other device to measure each dose accurately.

The average household teaspoon may not hold the right amount of liquid. To help clear up your infection completely, keep using this medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop taking this medicine too soon, your symptoms may return.

Is sulfamethoxazole fast acting?

6. Response and effectiveness –

Sulfamethoxazole/trimethoprim is quickly absorbed with peak levels occurring within one to four hours after oral administration. The antibacterial effects of sulfamethoxazole/trimethoprim persist for at least 12 hours.

Can you take sulfamethoxazole for 3 days?

DOSAGE & INDICATIONS – For the treatment of Pneumocystis pneumonia (PCP). For the treatment of PCP in persons living with HIV. Oral dosage Adults 15 to 20 mg/kg/day (trimethoprim component) PO divided every 6 to 8 hours (Max: 1,600 mg trimethoprim/day) or 320 mg trimethoprim/1,600 mg sulfamethoxazole PO 3 times daily for 21 days then chronic suppressive therapy.

1. Adolescents 15 to 20 mg/kg/day (trimethoprim component) PO divided every 6 to 8 hours (Max: 1,600 mg trimethoprim/day) or 320 mg trimethoprim/1,600 mg sulfamethoxazole PO 3 times daily for 21 days then chronic suppressive therapy.
2. Infants and Children 2 months to 12 years 15 to 20 mg/kg/day (trimethoprim component) PO divided every 6 hours (Max: 1,600 mg trimethoprim/day) for 21 days then chronic suppressive therapy.

Intravenous dosage Adults 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for 21 days then chronic suppressive therapy. Infants, Children, and Adolescents 2 months to 17 years 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for 21 days then chronic suppressive therapy.

1. For the treatment of PCP in solid organ transplant recipients.
2. Oral dosage Adults 15 to 20 mg/kg/day (trimethoprim component) PO divided every 6 to 8 hours (Max: 1,600 mg trimethoprim/day) or 320 mg trimethoprim/1,600 mg sulfamethoxazole PO 3 times daily for 14 to 21 days.
3. Adolescents 15 to 20 mg/kg/day (trimethoprim component) PO divided every 6 to 8 hours (Max: 1,600 mg trimethoprim/day) or 320 mg trimethoprim/1,600 mg sulfamethoxazole PO 3 times daily for 14 to 21 days.

Infants and Children 2 months to 12 years 15 to 20 mg/kg/day (trimethoprim component) PO divided every 6 to 8 hours (Max: 1,600 mg trimethoprim/day) for 14 to 21 days. Intravenous dosage Adults 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for 14 to 21 days.

• May consider the addition of caspofungin for salvage therapy.
• Infants, Children, and Adolescents 2 months to 17 years 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for 14 to 21 days.
• May consider the addition of caspofungin for salvage therapy.

For the treatment of PCP in patients with hematological malignancies, cancer, or autoimmune/inflammatory disease. Oral dosage Adults 15 to 20 mg/kg/day (trimethoprim component) PO divided every 6 to 8 hours (Max: 1,600 mg trimethoprim/day) for 14 to 21 days.

1. Infants, Children, and Adolescents 2 months to 17 years 15 to 20 mg/kg/day (trimethoprim component) PO divided every 6 hours (Max: 1,600 mg trimethoprim/day) for 14 to 21 days.
2. Intravenous dosage Adults 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for 14 to 21 days.

May consider the addition of caspofungin for salvage therapy. Infants, Children, and Adolescents 2 months to 17 years 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for 14 to 21 days. May consider the addition of caspofungin for salvage therapy.

For Pneumocystis pneumonia (PCP) prophylaxis. For primary PCP prophylaxis in HIV-infected patients. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily. Alternatively, 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times weekly.

Recommended for patients with CD4 count less than 200 cells/mm3, CD4 less than 14%, or CD4 count of 200 to 250 cells/mm3 if antiretroviral therapy (ART) initiation must be delayed and if CD4 count monitoring every 3 months is not possible. May discontinue if the CD4 count is 200 cells/mm3 or more for more than 3 months in response to ART or if the CD4 count is 100 to 200 cells/mm3 and HIV RNA remains below the limit of detection for 3 to 6 months.

• Restart prophylaxis if CD4 count is less than 100 cells/mm3 or CD4 count is 100 to 200 cells/mm3 and HIV RNA is above detection limit.
• Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily.
• Alternatively, 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times weekly.

Recommended for patients with CD4 count less than 200 cells/mm3, CD4 less than 14%, or CD4 count of 200 to 250 cells/mm3 if antiretroviral therapy (ART) initiation must be delayed and if CD4 count monitoring every 3 months is not possible. May discontinue if the CD4 count is 200 cells/mm3 or more for more than 3 months in response to ART or if the CD4 count is 100 to 200 cells/mm3 and HIV RNA remains below the limit of detection for 3 to 6 months.

Restart prophylaxis if CD4 count is less than 100 cells/mm3 or CD4 count is 100 to 200 cells/mm3 and HIV RNA is above detection limit. Children 6 to 12 years 2.5 to 5 mg/kg/dose (trimethoprim component) PO twice daily or 2 or 3 times weekly or 5 to 10 mg/kg/dose (trimethoprim component) PO once daily (Max: 320 mg trimethoprim/day).

Recommended for patients with CD4 count less than 200 cells/mm3 or CD4 less than 15%. May discontinue after 6 months or more of antiretroviral therapy if the CD4 count is 200 cells/mm3 or more or CD4 is 15% or more for more than 3 consecutive months. Restart prophylaxis if CD4 count is less than 200 cells/mm3 or CD4 is less than 15%.

1. Children 1 to 5 years 2.5 to 5 mg/kg/dose (trimethoprim component) PO twice daily or 2 or 3 times weekly or 5 to 10 mg/kg/dose (trimethoprim component) PO once daily.
2. Recommended for patients with CD4 count less than 500 cells/mm3 or CD4 less than 15%.
3. May discontinue after 6 months or more of antiretroviral therapy if the CD4 count is 500 cells/mm3 or more or CD4 is 15% or more for more than 3 consecutive months.

Restart prophylaxis if CD4 count is less than 500 cells/mm3 or CD4 is less than 15%. Infants 2 to 11 months 2.5 to 5 mg/kg/dose (trimethoprim component) PO twice daily or 2 or 3 times weekly or 5 to 10 mg/kg/dose (trimethoprim component) PO once daily.

Recommended for all HIV-infected or HIV-indeterminate infants younger than 12 months regardless of CD4 count or percentage. Consider prophylaxis for infants born to HIV-infected mothers beginning at 4 to 6 weeks. Discontinue prophylaxis in infants with indeterminate HIV infection status when they are determined to be definitively ore presumptively HIV-uninfected.

Do not discontinue prophylaxis in HIV-infected infants younger than 12 months. For secondary PCP prophylaxis (i.e., long-term suppressive therapy) in HIV-infected patients. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily.

Alternatively, 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times weekly. May discontinue if the CD4 count is more than 200 cells/mm3 for more than 3 months in response to antiretroviral therapy (ART) or if the CD4 count is 100 to 200 cells/mm3 and HIV RNA remains below the limit of detection for 3 to 6 months.

Restart prophylaxis if CD4 count is less than 100 cells/mm3 or CD4 count is 100 to 200 cells/mm3 and HIV RNA is above detection limit. If PCP is diagnosed or recurs at a CD4 count of more than 200 cells/mm3, lifelong prophylaxis is necessary. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily.

• Alternatively, 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times weekly.
• May discontinue if the CD4 count is more than 200 cells/mm3 for more than 3 months in response to antiretroviral therapy (ART) or if the CD4 count is 100 to 200 cells/mm3 and HIV RNA remains below the limit of detection for 3 to 6 months.

Restart prophylaxis if CD4 count is less than 100 cells/mm3 or CD4 count is 100 to 200 cells/mm3 and HIV RNA is above detection limit. If PCP is diagnosed or recurs at a CD4 count of more than 200 cells/mm3, lifelong prophylaxis is necessary. Children 6 to 12 years 2.5 to 5 mg/kg/dose (trimethoprim component) PO twice daily or 2 or 3 times weekly or 5 to 10 mg/kg/dose (trimethoprim component) PO once daily (Max: 320 mg trimethoprim/day).

May discontinue after 6 months or more of antiretroviral therapy if the CD4 count is 200 cells/mm3 or more or CD4 is 15% or more for more than 3 consecutive months. Restart prophylaxis if CD4 count is less than 200 cells/mm3 or CD4 is less than 15%. Children 1 to 5 years 2.5 to 5 mg/kg/dose (trimethoprim component) PO twice daily or 2 or 3 times weekly or 5 to 10 mg/kg/dose (trimethoprim component) PO once daily.

May discontinue after 6 months or more of antiretroviral therapy if the CD4 count is 500 cells/mm3 or more or CD4 is 15% or more for more than 3 consecutive months. Restart prophylaxis if CD4 count is less than 500 cells/mm3 or CD4 is less than 15%. Infants 2 to 11 months 2.5 to 5 mg/kg/dose (trimethoprim component) PO twice daily or 2 or 3 times weekly or 5 to 10 mg/kg/dose (trimethoprim component) PO once daily.

• Do not discontinue prophylaxis in HIV-infected infants younger than 12 months.
• For primary PCP prophylaxis in hematopoietic stem cell transplantation (HSCT) recipients.
• Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily starting at engraftment or 1 to 2 weeks before HSCT and continuing for at least 6 months after HSCT.

Recommended for all allogenic HSCT recipients and autologous HSCT recipients with underlying hematologic malignancies, those receiving intense conditioning therapy or graft manipulation, or those who have received purine analogs. Longer-term prophylaxis is recommended for the duration of immunosuppression for all patients who are receiving immunosuppressive therapy or have chronic graft-versus-host disease.

• Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily starting at engraftment or 1 to 2 weeks before HSCT and continuing for at least 6 months after HSCT.
• Recommended for all allogenic HSCT recipients and autologous HSCT recipients with underlying hematologic malignancies, those receiving intense conditioning therapy or graft manipulation, or those who have received purine analogs.

Longer-term prophylaxis is recommended for the duration of immunosuppression for all patients who are receiving immunosuppressive therapy or have chronic graft-versus-host disease. Infants and Children 2 months to 12 years 150 mg/m2/day (trimethoprim component) PO once daily on 3 consecutive days/week or divided twice daily on 3 or 7 days/week (Max: 320 mg trimethoprim/day) starting at engraftment or 1 to 2 weeks before HSCT and continuing for at least 6 months after HSCT.

Recommended for all allogenic HSCT recipients and autologous HSCT recipients with underlying hematologic malignancies, those receiving intense conditioning therapy or graft manipulation, or those who have received purine analogs. Longer-term prophylaxis is recommended for the duration of immunosuppression for all patients who are receiving immunosuppressive therapy or have chronic graft-versus-host disease.

For PCP prophylaxis in solid organ transplant recipients. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily for 3 to 6 months after kidney transplant, for at least 6 to 12 months after other transplants, as well as for at least 6 weeks during and after antirejection therapy in kidney transplant recipients.

1. Lifelong prophylaxis is recommended for lung and small bowel transplant recipients, as well as patients with a history of prior PCP or chronic cytomegalovirus disease.
2. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily for 3 to 6 months after kidney transplant, for at least 6 to 12 months after other transplants, as well as for at least 6 weeks during and after antirejection therapy in kidney transplant recipients.

Lifelong prophylaxis is recommended for lung and small bowel transplant recipients, as well as patients with a history of prior PCP or chronic cytomegalovirus disease. Infants and Children 2 months to 12 years 5 to 10 mg/kg/day (trimethoprim component) PO once daily on 7 days/week or divided twice daily on 2 or 3 days/week (Max: 320 mg trimethoprim/day) for 3 to 6 months after kidney transplant, for at least 6 to 12 months after other transplants, as well as for at least 6 weeks during and after antirejection therapy in kidney transplant recipients.

1. Lifelong prophylaxis is recommended for lung and small bowel transplant recipients, as well as patients with a history of prior PCP or chronic cytomegalovirus disease.
2. For primary PCP prophylaxis in patients with cancer-related immunosuppression and hematological malignancies.
3. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily.

Recommended for patients receiving alemtuzumab, fludarabine/cyclophosphamide/rituximab, corticosteroids at doses equivalent to more than 20 mg/day of prednisone for 4 weeks, nucleoside or purine analogs, radiotherapy for brain tumors/metastasis plus high-dose steroids as well as for patients with acute lymphoblastic leukemia (ALL) and lymphoma treated with R-CHOP14 or escalated BEACOPP.

1. Duration of prophylaxis for ALL is from induction to the end of maintenance.
2. Prophylaxis for alemtuzumab-associated treatment and fludarabine/cyclophosphamide/rituximab treatment is suggested for at least 6 months after treatment completion.
3. Infants, Children, and Adolescents 2 months to 17 years 150 mg/m2/day (trimethoprim component) PO once or twice daily, 2 or 3 times weekly, or once weekly (Max: 320 mg trimethoprim/day).

Recommended for patients receiving alemtuzumab or corticosteroids at doses equivalent to more than 0.4 mg/kg/day or 16 mg/day of prednisone for 1 month or more as well as patients with acute lymphoblastic leukemia (ALL), severe combined immunodeficiency (SCID), Wiskott-Aldrich syndrome (WAS), X-linked agammaglobulinemia, human leukocyte antigen (HLA) II combined immunodeficiency, acute myeloid leukemia (AML), and solid tumors.

Duration of prophylaxis for ALL is from induction to the end of maintenance. Patients receiving corticosteroids or with SCID, WAS, X-linked agammaglobulinemia, or HLA II combined immunodeficiency require lifelong prophylaxis or until restoration of the underlying defect. Prophylaxis is recommended for patients with AML and solid tumors for the duration of chemotherapy.

For primary PCP prophylaxis in dermatology and rheumatology patients receiving corticosteroids. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 3 times weekly or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily or 3 times weekly.

Recommended for patients receiving corticosteroids at doses equivalent to 20 mg/day or more of prednisone for 4 weeks or more, particularly if an additional risk factor is present. For the treatment of otitis media. Oral dosage Adults† 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours. Infants, Children, and Adolescents 2 months to 17 years 8 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 10 days is recommended in FDA-approved labeling.

The American Academy of Pediatrics (AAP) does not recommend sulfamethoxazole; trimethoprim as a treatment option in patients with type I penicillin allergy due to the low rates of cross sensitivity between penicillin and second and third generation cephalosporins, which are the recommended alternative agents.

1. Sulfamethoxazole; trimethoprim is also not recommended as second-line therapy for children who have failed amoxicillin therapy due to high rates of pneumococcal resistance.
2. For the treatment of acute bacterial exacerbations of chronic bronchitis.
3. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 5 to 7 days.

The FDA-approved treatment duration is 14 days. For the treatment of asymptomatic bacteriuria† and urinary tract infection (UTI), including cystitis, pyelonephritis, catheter-associated urinary tract infection, and infections with difficult-to-treat resistance.

For the treatment of catheter-associated UTI. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 8 to 12 hours for 7 to 14 days. Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 7 to 14 days.

Intravenous dosage Adults 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours for 7 to 14 days. Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours (Max: 960 mg trimethoprim/day) for 7 to 14 days.

For the treatment of acute uncomplicated cystitis in nonpregnant persons, including infections with difficult-to-treat resistance. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 3 days. For the treatment of severe UTI, including pyelonephritis and infections with difficult-to-treat resistance.

Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 14 days. Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 7 to 14 days.

• Intravenous dosage Adults 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours for 14 days.
• Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours (Max: 960 mg trimethoprim/day).
• Treat for 24 to 48 hours or until patient is clinically stable and afebrile, followed by oral antibiotics for a total duration of 7 to 14 days.

For the treatment of nonspecific UTI. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 10 to 14 days. Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 10 days.

1. For the treatment of lower UTI with prostate involvement.
2. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 7 days.
3. For the treatment of acute uncomplicated lower urinary tract infection in pediatric patients.
4. Oral dosage Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 3 to 5 days.

For the treatment of asymptomatic bacteriuria†. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 3 days. For urinary tract infection (UTI) prophylaxis†. For continuous, long-term UTI prophylaxis† for recurrent infections.

• Oral dosage Adults 40 mg trimethoprim/200 mg sulfamethoxazole PO every 24 hours or 3 times weekly.
• The duration of prophylaxis is variable and should be assessed routinely.
• Generally 3 to 12 months is suggested; however, longer durations have been used.
• Infants, Children, and Adolescents 2 months to 17 years 2 mg/kg/dose (trimethoprim component) PO every 24 hours or 5 mg/kg/dose (trimethoprim component) PO 2 times weekly.

For intermittent, pre- or post-coital UTI prophylaxis† for recurrent infections. Oral dosage Adults 40 mg trimethoprim/200 mg sulfamethoxazole or 80 mg trimethoprim/400 mg sulfamethoxazole as a single dose as needed. For UTI prophylaxis† in infants with hydronephrosis or vesicoureteral reflux.

NOTE: Routine antimicrobial prophylaxis for patients aged 2 to 24 months with vesicoureteral reflux is not supported by currently available data; however, antimicrobial prophylaxis is still utilized and has biological plausibility. Oral dosage Infants and Children 2 months to 2 years 2 mg/kg/dose (trimethoprim component) PO every 24 hours or 5 mg/kg/dose (trimethoprim component) PO 2 times weekly.

Prophylaxis is recommended in high-risk patients, which includes infants and children with recurrent febrile UTI and infants and children with reflux grade of III or higher. Guidelines recommend antibiotic prophylaxis for all grades of vesicoureteral reflux in all patients younger than 1 year.

For bacterial infection prophylaxis† in HIV-infected children and infants. For secondary prophylaxis† in HIV-infected children with recurrent, severe bacterial infections. Oral dosage Infants and Children 2 months to 12 years 150 mg/m2/day (trimethoprim component) PO divided every 12 hours. Secondary prophylaxis is only recommended for infants and children with more than 2 serious bacterial infections in a 1-year period who are unable to take antiretroviral therapy.

Secondary prophylaxis may be discontinued for sustained (3 months or more) immune reconstitution (CD4 at least 25% if 6 years or younger; CD4 at least 20% or CD4 count more than 350 cells/mm3 if older than 6 years). Secondary prophylaxis should be restarted for more than 2 serious bacterial infections in a 1-year period despite antiretroviral therapy.

• For primary prophylaxis† to reduce opportunistic infection in HIV-infected children (regardless of CD4 count).
• Oral dosage Infants and Children 2 months to 12 years 150 mg/m2/day (trimethoprim component) PO divided every 12 hours may be considered an alternative treatment to decrease the rate of serious bacterial infections in HIV-infected infants and children unable to take antiretroviral therapy; however, guidelines do not recommend routine primary prophylaxis of bacterial infections, when not indicated for PCP or MAC prophylaxis or other specific reasons.

A randomized, double-blind, placebo-controlled study in Zambian children aged 1 to 14 years (n = 541) with clinical features of HIV-infection evaluated the efficacy of sulfamethoxazole; trimethoprim (SMX-TMP) in reducing opportunistic infections in an area with high levels of in vitro bacterial resistance to SMX-TMP.

• Children younger than 5 years received 240 mg (5 mL of suspension) PO daily and those 5 years and older received 480 mg (10 mL suspension) PO daily or matching placebo.
• SMX-TMP reduced mortality by 43% and hospitalization by 23% compared to placebo.
• It was concluded that children of all ages with clinical features of HIV infection receive SMX-TMP prophylaxis in resource-poor areas, regardless of local resistance to the antibiotic.

For the treatment of toxoplasmic encephalitis† (TE) due to Toxoplasma gondii, Oral dosage Adults 5 mg/kg/dose (trimethoprim component) PO every 12 hours as an alternative regimen, then chronic maintenance therapy. Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks.

Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically.

Adolescents 5 mg/kg/dose (trimethoprim component) PO every 12 hours as an alternative regimen, then chronic maintenance therapy. Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks.

Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically.

Infants and Children 2 months to 12 years 5 mg/kg/dose (trimethoprim component) PO every 12 hours has been used as an alternative regimen in adults; however, this regimen has not been evaluated in children. Intravenous dosage Adults 5 mg/kg/dose (trimethoprim component) IV every 12 hours as an alternative regimen, then chronic maintenance therapy.

Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible.

Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically. Adolescents 5 mg/kg/dose (trimethoprim component) IV every 12 hours as an alternative regimen, then chronic maintenance therapy.

Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible.

Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically. Infants and Children 2 months to 12 years 5 mg/kg/dose (trimethoprim component) IV every 12 hours has been used as an alternative regimen in adults; however, this regimen has not been evaluated in children.

For toxoplasmosis prophylaxis†, specifically prevention of toxoplasmic encephalitis (TE) due to Toxoplasma gondii, For primary prophylaxis† in HIV-infected patients. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily in patients with an IgG antibody to Toxoplasma and a CD4+ count less than 100 cells/mm3.

As an alternative, may give 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times per week or 80 mg trimethoprim/400 mg sulfamethoxazole PO daily. Primary prophylaxis for TE may be discontinued in patients who have responded to highly active antiretroviral therapy with an increase in CD4 count to more than 200 cells/mm3 for at least 3 months.

Prophylaxis should be reintroduced if CD4 count decreases to less than 100 to 200 cells/mm3. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily in patients with an IgG antibody to Toxoplasma and a CD4+ count less than 100 cells/mm3. As an alternative, may give 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times per week or 80 mg trimethoprim/400 mg sulfamethoxazole PO daily.

Primary prophylaxis for TE may be discontinued in patients who have responded to highly active antiretroviral therapy with an increase in CD4 count to more than 200 cells/mm3 for at least 3 months. Prophylaxis should be reintroduced if CD4 count decreases to less than 100 to 200 cells/mm3.

Infants and Children 2 months to 12 years 150 mg/m2 trimethoprim/750 mg/m2 sulfamethoxazole PO once daily (Max: 160 mg trimethoprim/800 mg sulfamethoxazole/day) in patients with an IgG antibody to Toxoplasma and severe immunosuppression (i.e., infants and children younger than 6 years of age with a CD4 percentage less than 15% or children 6 years and older with a CD4 count less than 100 cells/mm3).

Acceptable alternative regimens include 150 mg/m2 trimethoprim/750 mg/m2 sulfamethoxazole PO once daily for 3 consecutive days each week, 150 mg/m2 trimethoprim/750 mg/m2 sulfamethoxazole PO per day in 2 divided doses given every day, or 150 mg/m2 trimethoprim/750 mg/m2 sulfamethoxazole PO per day in 2 divided doses given 3 times per week on alternate days (e.g., Monday, Wednesday, Friday).

1. Prophylaxis should not be discontinued in infants younger than 1 year of age.
2. For children 1 to 5 years of age, primary prophylaxis may be discontinued after at least 6 months of antiretroviral therapy if CD4 percentage is at least 15% for more than 3 consecutive months.
3. For children 6 years and older, primary prophylaxis may be discontinued after at least 6 months of antiretroviral therapy if CD4 count is more than 200 cells/mm3 for more than 3 consecutive months.

Primary prophylaxis should be restarted if CD4 counts fall below these thresholds. For chronic maintenance therapy† (secondary prophylaxis†) after acute toxoplasmosis infection. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or twice daily is recommended as an alternative in the HIV guidelines.

Once daily therapy may be associated with an increased risk of relapse; therefore, a gradual transition from acute therapy may be beneficial, utilizing the twice daily dose for 4 to 6 weeks before switching to once daily dosing. Chronic maintenance therapy may be discontinued if initial therapy is successfully completed, patient remains free of signs and symptoms of encephalitis, and has a CD4 count more than 200 cells/mm3 for more than 6 months in response to antiretroviral therapy.

Restart chronic maintenance therapy if the CD4 count drops below 200 cells/mm3. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or twice daily is recommended as an alternative in the HIV guidelines. Once daily therapy may be associated with an increased risk of relapse; therefore, a gradual transition from acute therapy may be beneficial, utilizing the twice daily dose for 4 to 6 weeks before switching to once daily dosing.

Chronic maintenance therapy may be discontinued if initial therapy is successfully completed, patient remains free of signs and symptoms of encephalitis, and has a CD4 count more than 200 cells/mm3 for more than 6 months in response to antiretroviral therapy. Restart chronic maintenance therapy if the CD4 count drops below 200 cells/mm3.

Infants and Children 2 months to 12 years 150 mg/m2 trimethoprim/750 mg/m2 sulfamethoxazole PO once daily (Max: 160 mg trimethoprim/800 mg sulfamethoxazole/day) is recommended as an alternative by guidelines. There are very limited data for alternative regimens in children and trimethoprim/sulfamethoxazole is only recommended in patients who are intolerant to other preferred regimens.

Chronic maintenance therapy may be discontinued in patients who have received antiretroviral therapy for at least 6 months, have successfully completed initial therapy and remain free of signs and symptoms of encephalitis, and have a CD4 count of at least 15% (1 to 5 years of age) or more than 200 cells/mm3 (6 years and older) for more than 6 months.

Restart chronic maintenance therapy if the CD4 count drops below these thresholds. For primary prophylaxis† in allogeneic hematopoietic stem cell transplantation (HSCT) recipients with IgG antibody to Toxoplasma, NOTE: Prophylaxis should be started after engraftment and given as long as the patient remains on immunosuppressant therapy (i.e., usually until 6 months after HSCT).

1. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily; or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily; or 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times per week.
2. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily; or 80 mg trimethoprim/400 mg sulfamethoxazole PO once daily; or 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times per week.

Infants and Children 2 months to 12 years 150 mg/m2 trimethoprim/750 mg/m2 sulfamethoxazole per day PO in 1 of the following regimens: 2 divided doses 3 times weekly on consecutive days, a single dose 3 times weekly on consecutive days, 2 divided doses daily, or 2 divided doses 3 times weekly on alternate days (Max: 160 mg trimethoprim/800 mg sulfamethoxazole/day).

For the treatment of Legionnaire’s disease† caused by Legionella pneumophila, Intravenous dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole IV every 8 hours. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours. For the treatment of actinomycotic mycetoma†. For actinomycotic mycetoma† caused by Actinomadura pelletierii, Actinomadura madurae, Streptomyces somaliensis,

Oral dosage Adults 23 mg/kg/day PO of sulfamethoxazole and 4.6 mg/kg/day of trimethoprim PO in two divided doses in combination with streptomycin. For actinomycotic mycetoma† caused by Nocardia brasiliensis, Nocardia asteroides, or Nocardia otitidiscaviarum,

Oral dosage Adults 45 mg/kg/day PO of sulfamethoxazole and 9 mg/kg/day of trimethoprim PO in two divided doses in combination with dapsone or amikacin. For the treatment of nocardiosis† caused by Nocardia sp. Oral dosage Adults Uncertainty exists regarding the dose of co-trimoxazole for this condition.

A retrospective review of 19 patients at Duke University who received co-trimoxazole for treatment of documented Nocardia infection revealed that patients received an average of 8.2 regular strength tablets/day for an average of 7.2 months. Resolution was achieved in 17/19 patients and in 9/19, co-trimoxazole was the only form of therapy given.

• For the treatment of pertussis (whooping cough)† caused by Bordetella pertussis or for postexposure pertussis prophylaxis†.
• Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 14 days is recommended as an alternative to a macrolide.
• For postexposure prophylaxis, administer to asymptomatic close contacts within 3 weeks of exposure, especially patients at high risk for pertussis-related complications (e.g., pregnant women in third trimester).

Symptomatic contacts (coughing) should be treated as if they have pertussis. Infants, Children, and Adolescents 2 months to 17 years 8 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 14 days is recommended as an alternative to a macrolide.

For postexposure prophylaxis, administer to asymptomatic close contacts within 3 weeks of exposure, especially patients at high risk for pertussis-related complications (e.g., infants younger than 12 months). Symptomatic contacts (coughing) should be treated as if they have pertussis. For the treatment of bacteremia† and catheter-associated infections†.

For the treatment of catheter-associated infections†. Intravenous dosage Adults 3 to 5 mg/kg/dose (trimethoprim component) IV every 8 hours. Infants, Children, and Adolescents 2 months to 17 years 6 to 12 mg/kg/day (trimethoprim component) IV divided every 12 hours (Max: 960 mg trimethoprim/day) for mild-to-moderate infections and 15 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 8 hours (Max: 960 mg trimethoprim/day) for certain serious catheter-associated infections.

• For the treatment of methicillin-resistant S.
• Aureus (MRSA) bacteremia†.
• Intravenous dosage Adults 5 mg/kg/dose (trimethoprim component) IV every 12 hours in combination plus high dose daptomycin in patients with persistent MRSA bacteremia and vancomycin treatment failures.
• If there is reduced susceptibility to vancomycin and daptomycin, sulfamethoxazole; trimethoprim may be administered as a single agent or in combination with other antibiotics.

For the treatment of bacteremia due to resistant gram-negative organisms†. Oral dosage Adults 8 to 10 mg/kg/day (trimethoprim component) PO divided every 8 to 12 hours (Max: 320 mg/dose trimethoprim component). Inravenous dosage Adults 8 to 10 mg/kg/day (trimethoprim component) IV divided every 8 to 12 hours.

1. For primary or secondary spontaneous bacterial peritonitis prophylaxis†.
2. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily.
3. For the treatment of infectious diarrhea and gastroenteritis, including cyclosporiasis†, cystoisosporiasis†, salmonellosis†, shigellosis, traveler’s diarrhea due to enterotoxigenic E.

coli, and yersiniosis†. For the treatment of cyclosporiasis† in persons without HIV. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 10 days. Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 7 to 10 days.

For the treatment of cyclosporiasis† in persons living with HIV. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO 4 times daily for 10 days, then 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 3 weeks. For the treatment of cystoisosporiasis† in persons without HIV. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 10 days.

Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 7 to 10 days. For the treatment of cystoisosporiasis† in persons living with HIV.

• Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO 4 times daily for 10 days or 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 10 days; may start with twice-daily dosing and increase dose and/or duration to 3 to 4 weeks if symptoms worsen or persist.
• Follow with long-term suppressive therapy in persons with a CD4 count less than 200/mm3.

Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO 4 times daily for 10 days or 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 10 days; may start with twice-daily dosing and increase dose and/or duration to 3 to 4 weeks if symptoms worsen or persist.

Follow with long-term suppressive therapy in persons with a CD4 count less than 200/mm3. Infants and Children 2 months to 12 years 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 10 days; may increase dose to 20 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 640 mg trimethoprim/3,200 mg sulfamethoxazole/day) and/or duration to 3 to 4 weeks if symptoms worsen or persist.

Follow with long-term suppressive therapy in persons with severe immunosuppression. Intravenous dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole IV 4 times daily for 10 days or 160 mg trimethoprim/800 mg sulfamethoxazole IV twice daily for 7 to 10 days; may start with twice-daily dosing and increase dose and/or duration to 3 to 4 weeks if symptoms worsen or persist.

Follow with long-term suppressive therapy in persons with a CD4 count less than 200/mm3. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole IV 4 times daily for 10 days or 160 mg trimethoprim/800 mg sulfamethoxazole IV twice daily for 7 to 10 days; may start with twice-daily dosing and increase dose and/or duration to 3 to 4 weeks if symptoms worsen or persist.

Follow with long-term suppressive therapy in persons with a CD4 count less than 200/mm3. Infants and Children 2 months to 12 years 10 mg/kg/day (trimethoprim component) IV divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 10 days; may increase dose to 20 mg/kg/day (trimethoprim component) IV divided every 12 hours (Max: 640 mg trimethoprim/3,200 mg sulfamethoxazole/day) and/or duration to 3 to 4 weeks if symptoms worsen or persist.

Follow with long-term suppressive therapy in persons with severe immunosuppression. For the treatment of salmonellosis† in persons without HIV. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 48 to 72 hours or until the patient becomes afebrile. Routine use is not recommended; reserve for patients at high risk for invasive infection.

Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 48 to 72 hours or until the patient becomes afebrile. Routine use is not recommended; reserve for patients at high risk for invasive infection.

For the treatment of salmonellosis† in persons living with HIV. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 14 days as an alternative; treat for at least 14 days if concurrent bacteremia in persons with a CD4 count more than 200 cells/mm3. Treat for 2 to 6 weeks in persons with a CD4 count less than 200 cells/mm3.

Follow with long-term suppressive therapy if recurrent bacteremia or gastroenteritis with a CD4 count less than 200 cells/mm3 and severe diarrhea. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 14 days as an alternative; treat for at least 14 days if concurrent bacteremia in persons with a CD4 count more than 200 cells/mm3.

1. Treat for 2 to 6 weeks in persons with a CD4 count less than 200 cells/mm3.
2. Follow with long-term suppressive therapy if recurrent bacteremia or gastroenteritis with a CD4 count less than 200 cells/mm3 and severe diarrhea.
3. Intravenous dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole IV twice daily for 7 to 14 days as an alternative; treat for at least 14 days if concurrent bacteremia in persons with a CD4 count more than 200 cells/mm3.

Treat for 2 to 6 weeks in persons with a CD4 count less than 200 cells/mm3. Follow with long-term suppressive therapy if recurrent bacteremia or gastroenteritis with a CD4 count less than 200 cells/mm3 and severe diarrhea. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole IV twice daily for 7 to 14 days as an alternative; treat for at least 14 days if concurrent bacteremia in persons with a CD4 count more than 200 cells/mm3.

Treat for 2 to 6 weeks in persons with a CD4 count less than 200 cells/mm3. Follow with long-term suppressive therapy if recurrent bacteremia or gastroenteritis with a CD4 count less than 200 cells/mm3 and severe diarrhea. For the treatment of shigellosis in persons without HIV. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 5 days.

Infants, Children, and Adolescents 2 months to 17 years 8 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 5 days. Intravenous dosage Adults 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours for 5 days.

1. Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours for 5 days.
2. For the treatment of shigellosis in persons living with HIV.
3. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 10 days as an alternative; treat for at least 14 days if concurrent bacteremia.

Treat for up to 6 weeks for recurrent infections. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 10 days as an alternative; treat for at least 14 days if concurrent bacteremia. Treat for up to 6 weeks for recurrent infections.

Intravenous dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole IV twice daily for 7 to 10 days as an alternative; treat for at least 14 days if concurrent bacteremia. Treat for up to 6 weeks for recurrent infections. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole IV twice daily for 7 to 10 days as an alternative; treat for at least 14 days if concurrent bacteremia.

Treat for up to 6 weeks for recurrent infections. For the treatment of traveler’s diarrhea due to enterotoxigenic E. coli, Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 3 to 5 days. Guidelines do not include trimethoprim; sulfamethoxazole.

For the treatment of yersiniosis†. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 7 to 14 days as first-line therapy; treat for 14 days if concurrent bacteremia. Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 7 to 14 days as first-line therapy; treat for 14 days if concurrent bacteremia.

For the treatment of typhoid fever†. For the treatment of fully sensitive uncomplicated typhoid fever†. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO 2 or 4 times daily for 14 days as an alternative. Infants, Children, and Adolescents 2 months to 17 years 8 to 12 mg/kg/day (trimethoprim component) PO divided 2 or 4 times daily (Max: 640 mg trimethoprim/day) for 14 days as an alternative.

For the treatment of fully sensitive severe typhoid fever†. Intravenous dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole IV 2 or 4 times daily for 14 days as an alternative. Infants, Children, and Adolescents 2 months to 17 years 8 to 12 mg/kg/day (trimethoprim component) IV divided 2 or 4 times daily (Max: 640 mg trimethoprim/day) for 14 days as an alternative.

For the treatment of Staphylococcus aureus infections†, including endocarditis†. Intravenous dosage Adults In a prospective, randomized, double-blind trial, SMX-TMP dosed as 320 mg trimethoprim IV every 12 hours was compared to vancomycin in IV drug abusers with infections due to Staphylococcus aureus.

Although the cure rate was significantly higher with vancomycin after roughly 3 weeks of therapy (e.g., 98% for vancomycin vs.86% for SMX-TMP), the authors concluded that SMX-TMP could be considered an alternative in patients who cannot receive vancomycin if infection is due to methicillin-sensitive S.

aureus. Clinical practice guidelines do not recommend SMX-TMP for endocarditis but acknowledge occasional use as salvage therapy. For the treatment of skin and skin structure infections†, including impetigo†, cellulitis†, erysipelas†, skin abscesses†, furunculosis†, carbuncle†, animal bite wounds†, leg ulcer†, diabetic foot ulcer†, and surgical incision site infections†.

1. For the treatment of animal bite wounds†.
2. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours.
3. In setting of a cat or dog bite, preemptive early antimicrobial therapy for 3 to 5 days is recommended for patients who are immunocompromised, asplenic, have advanced liver disease, have edema of the bite area, have moderate to severe injuries, particularly of the hand or face, or have penetrating injuries to the periosteum or joint capsule.

Intravenous dosage Adults 5 to 10 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours. In setting of a cat or dog bite, preemptive early antimicrobial therapy for 3 to 5 days is recommended for patients who are immunocompromised, asplenic, have advanced liver disease, have edema of the bite area, have moderate to severe injuries, particularly of the hand or face, or have penetrating injuries to the periosteum or joint capsule.

• For the treatment of surgical incision site infections†.
• Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 6 hours for incisional surgical site infections of the trunk or extremity away from the axilla or perineum.
• For the treatment of impetigo when methicillin-resistant S.
• Aureus is suspected or confirmed†.

Oral dosage Adults 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole PO every 12 hours for 5 to 7 days. Infants, Children, and Adolescents 2 months to 17 years 4 to 6 mg/kg/dose (trimethoprim component) (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/dose) PO every 12 hours for 5 to 7 days.

• For the treatment of nonpurulent skin infections†, such as cellulitis† and erysipelas†.
• Oral dosage Adults 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole PO every 12 hours for 5 to 14 days.57437 Infants, Children, and Adolescents 2 months to 17 years 4 to 6 mg/kg/dose (trimethoprim component) (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/dose) PO every 12 hours for 5 to 14 days.

For the treatment of purulent skin infections†, such as furunculosis†, carbuncle†, and skin abscesses†. Oral dosage Adults 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole PO every 12 hours for 5 to 10 days plus incision and drainage. Infants, Children, and Adolescents 2 months to 17 years 4 to 6 mg/kg/dose (trimethoprim component) (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/dose) PO every 12 hours for 5 to 10 days plus incision and drainage.

• For the treatment of leg ulcer†.
• Oral dosage Adults 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole PO every 12 hours for 7 days.
• Intravenous dosage Adults 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole IV every 12 hours for 7 days.
• For the treatment of diabetic foot ulcer†.
• Oral dosage Adults 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole PO every 12 hours for 7 to 14 days for mild infections due to methicillin-resistant S.

aureus (MRSA) or other staphylococci or streptococci in patients allergic or intolerant to beta-lactams or moderate or severe infections in patients with risk factors for MRSA. Continue treatment for up to 28 days if infection is improving but is extensive and resolving slower than expected or if patient has severe peripheral artery disease.

1. Intravenous dosage Adults 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole IV every 12 hours for 7 to 14 days for mild infections due to methicillin-resistant S.
2. Aureus (MRSA) or other staphylococci or streptococci in patients allergic or intolerant to beta-lactams or moderate or severe infections in patients with risk factors for MRSA.

Continue treatment for up to 28 days if infection is improving but is extensive and resolving slower than expected or if patient has severe peripheral artery disease. For the treatment of skin and skin structure infections due to resistant gram-negative organisms†.

Oral dosage Adults 8 to 10 mg/kg/day (trimethoprim component) PO divided every 8 to 12 hours (Max: 320 mg/dose trimethoprim component). Intravenous dosage Adults 8 to 10 mg/kg/day (trimethoprim component) IV divided every 8 to 12 hours. For the treatment of granuloma inguinale† (Donovanosis). Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily as an alternative for at least 3 weeks and until all lesions have completely healed.

Consider adding a second antibiotic if lesions do not respond within the first few days of therapy. For pregnant and lactating patients, use erythromycin or azithromycin. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily as an alternative for at least 3 weeks and until all lesions have completely healed.

• Consider adding a second antibiotic if lesions do not respond within the first few days of therapy.
• For the treatment of pediculosis† capitis (head lice infestation).
• Oral dosage Adults 80 mg trimethoprim/400 mg sulfamethoxazole to 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 3 days has been used.

Retreat after 7 to 10 days. Children and Adolescents 5 mg/kg/dose (trimethoprim component) PO every 12 hours for 10 days has been used. Oral sulfamethoxazole/trimethoprim either alone or combined with topical 1% permethrin was effective; however, it was recommended that combination therapy be reserved for cases of lice resistance or multiple treatment failures.

For the treatment of melioidosis† and for postexposure prophylaxis. Oral dosage Adults weighing more than 60 kg 320 mg trimethoprim/1,600 mg sulfamethoxazole PO every 12 hours for 12 weeks for the oral eradication-phase of therapy after initial IV treatment and for 21 days as postexposure prophylaxis during a public health emergency.

Consider adding sulfamethoxazole; trimethoprim to carbapenem therapy in setting of persistent bacteremia. Adults weighing 40 to 60 kg 240 mg trimethoprim/1,200 mg sulfamethoxazole PO every 12 hours for 12 weeks for the oral eradication-phase of therapy after initial IV treatment and for 21 days as postexposure prophylaxis during a public health emergency.

• Consider adding sulfamethoxazole; trimethoprim to carbapenem therapy in setting of persistent bacteremia.
• Adults weighing less than 40 kg 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 12 weeks for the oral eradication-phase of therapy after initial IV treatment and for 21 days as postexposure prophylaxis during a public health emergency.

Consider adding sulfamethoxazole; trimethoprim to carbapenem therapy in setting of persistent bacteremia. Infants, Children, and Adolescents 2 months to 17 years 8 mg/kg/dose (trimethoprim component) PO every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/dose) for 12 weeks for the oral eradication-phase of therapy after initial IV treatment and for 21 days as postexposure prophylaxis during a public health emergency.

• Consider adding sulfamethoxazole; trimethoprim to carbapenem therapy in the setting of persistent bacteremia.
• For sulfonamide desensitization† in patients requiring sulfamethoxazole; trimethoprim therapy.
• Rapid sulfonamide desensitization† protocol.
• Oral dosage Adults This rapid protocol was studied in HIV infected patients who required SMX-TMP therapy.

Increasing doses of SMX-TMP are given every 15 minutes for 31 doses; then, if protocol tolerated, begin sulfonamide therapy as indicated. The protocol is as follows: Doses 1 to 3 (10 ng/mL SMX-TMP): 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.00007 mg of the SMX component.

Doses 4 to 7 (100 ng/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.00075 mg of the SMX component. Doses 8 to 11 (1 mcg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.0075 mg of the SMX component. Doses 12 to 15 (10 mcg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.075 mg of the SMX component.

Doses 16 to 19 (100 mcg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.75 mg of the SMX component. Doses 20 to 23 (1 mg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 7.5 mg of the SMX component.

Doses 24 to 27 (10 mg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 75 mg of the SMX component. Doses 28 to 30 (40 mg/mL SMX-TMP): 2 mL, 4 mL, and 8 mL PO given 15 minutes apart for a total dose of 560 mg of the SMX component. Dose 31: 1 double strength tablet (800 mg of the SMX component) PO.

Infants, Children, and Adolescents 2 months to 17 years Data on sulfonamide desensitization protocols are lacking in pediatric patients. In 1 rapid, 4-hour oral protocol in HIV-infected children (n = 5), sulfamethoxazole; trimethoprim suspension was diluted in sterile water, and doses were given every 15 minutes at the following proportions of the final dose: 1:10,000, 1:1,000, 1:500, 1:250, 1:125, 1:62, 1:30, 1:15, 1:7.5, 1:5, 1:2.5, and full strength.

• After desensitization, maintenance sulfamethoxazole; trimethoprim therapy was begun at a dosage of 150 mg/m2/day PO divided twice daily.
• The desensitization protocol was successful in 4 of the 5 patients.
• Another protocol in HIV-infected patients, 4 of whom were pediatric patients, used sulfamethoxazole; trimethoprim suspension administered orally every 8 hours beginning with 1:10,000 of the desired total daily dose and progressing through serial dilutions of 1:5,000, 1:1,000, 1:500, 1:100, 1:50, and 1:10.

Subsequently, the desired dosage was administered orally twice per day. The desensitization protocol was successful in 6 of the 7 patients. Ambulatory sulfonamide desensitization† protocol. Oral dosage Adults This ambulatory desensitization protocol was studied in HIV infected patients who required SMX-TMP prophylaxis.

• Increasing doses of SMX-TMP given PO 3 times daily were used for 8 days.
• On the ninth day and if protocol tolerated, the patients received 1 double-strength tablet (800 mg/160mg SMX-TMP) PO once daily.
• The protocol is as follows: Day 1 (0.00002 mg/mL SMX-TMP): 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.00007 mg of the SMX component.

Day 2 (0.0002 mg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.00075 mg of the SMX component. Day 3 (0.002 mg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.0075 mg of the SMX component.

Day 4 (0.02 mg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.075 mg of the SMX component. Day 5 (0.2 mg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 0.75 mg of the SMX component. Day 6 (2 mg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 7.5 mg of the SMX component.

Day 7 (20 mg/mL SMX-TMP): 0.5 mL, 1 mL, 2 mL, and 4 mL PO given 15 minutes apart for a total dose of 75 mg of the SMX component. Day 8 (40 mg/mL SMX-TMP): 2 mL, 4 mL, and 8 mL PO given 15 minutes apart for a total dose of 560 mg of the SMX component. Day 9: Give 1 double strength tablet (800 mg of the SMX component) PO.

Infants, Children, and Adolescents 2 months to 17 years Data on ambulatory sulfonamide desensitization protocols are lacking in pediatric patients. In 1 successful protocol in HIV-infected children (n = 4), 1 mL of sulfamethoxazole; trimethoprim oral suspension (8 mg/mL trimethoprim) was diluted with 19 mL of distilled water for a concentration of 0.4 mg/mL (used for Days 1 to 4 of the desensitization regimen).

The following desensitization regimen was used (all doses represent trimethoprim component): Day 1: 0.4 mg; Day 2: 0.8 mg; Day 3: 1.6 mg; Day 4: 3.2 mg; Day 5: 4.8 mg; Day 6: 9.6 mg; Day 7: 20 mg; Day 8: 40 mg; Day 9: 80 mg; Days 10 to 17: 40 mg; Days 18 onward: dose increased every 3 days to 5 mg/kg/day PO.

For the management of methicillin-resistant Staphylococcus aureus (MRSA)-associated bone and joint infections†, including osteomyelitis† and infectious arthritis†, infectious bursitis†, and orthopedic device-related infection†. For the management of methicillin-resistant Staphylococcus aureus (MRSA)-associated osteomyelitis†.

Oral dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) PO every 8 to 12 hours plus rifampin 600 mg PO daily. A minimum duration of 8 weeks is recommended; however, an additional 1 to 3 months (or longer for chronic infection or if no debridement performed) of oral rifampin plus another MRSA agent such as sulfamethoxazole/trimethoprim, may be necessary.

Intravenous dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) IV every 8 to 12 hours plus rifampin 600 mg PO daily. A minimum duration of 8 weeks is recommended; however, an additional 1 to 3 months (or longer for chronic infection or if no debridement performed) of oral rifampin plus another MRSA agent such as sulfamethoxazole/trimethoprim, may be necessary.

For the management of methicillin-resistant Staphylococcus aureus (MRSA)-associated infectious arthritis†. Oral dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) PO every 8 to 12 hours for 3 to 4 weeks. Intravenous dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) IV every 8 to 12 hours for 3 to 4 weeks.

1. For the management of methicillin-resistant Staphylococcus aureus (MRSA)-associated prosthetic joint infections†.
2. Oral dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) PO every 8 to 12 hours plus rifampin 600 mg PO daily or 300 to 450 mg PO every 12 hours for 2 weeks in patients with early-onset (less than 2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (3 weeks or less) of symptoms and debridement (but device retention).

Additional oral therapy (rifampin plus another MRSA agent, such as sulfamethoxazole; trimethoprim) should continue for 3 months for hip infections or for 6 months for knee infections. Intravenous dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) IV every 8 to 12 hours plus rifampin 600 mg PO daily or 300 to 450 mg PO every 12 hours for 2 weeks in patients with early-onset (less than 2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (3 weeks or less) of symptoms and debridement (but device retention).

Additional oral therapy (rifampin plus another MRSA agent, such as sulfamethoxazole; trimethoprim) should start after the completion of IV therapy and continue for 3 months for hip infections or for 6 months for knee infections. For the management of methicillin-resistant Staphylococcus aureus (MRSA)-associated spinal implant infections†.

Oral dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) PO every 8 to 12 hours plus rifampin 600 mg PO daily or 300 to 450 mg PO every 12 hours in patients with early-onset spinal implant infections (30 days or less after surgery) or implants in an actively infected site.

Prolonged oral therapy (rifampin plus another MRSA agent, such as sulfamethoxazole; trimethoprim) should follow parenteral therapy; however, the optimal duration of parenteral and/or oral therapy is unclear. Oral therapy should be continued until spine fusion has occurred. Long term oral suppressive therapy may be considered in select cases, especially if device removal is not possible.

Intravenous dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) IV every 8 to 12 hours plus rifampin 600 mg PO daily or 300 to 450 mg PO every 12 hours in patients with early-onset spinal implant infections (30 days or less after surgery) or implants in an actively infected site.

Prolonged oral therapy (rifampin plus another MRSA agent, such as sulfamethoxazole; trimethoprim) should follow parenteral therapy; however, the optimal duration of parenteral and/or oral therapy is unclear. Oral therapy should be continued until spine fusion has occurred. Long term oral suppressive therapy may be considered in select cases, especially if device removal is not possible.

For the management of methicillin-resistant Staphylococcus aureus (MRSA)-associated infectious bursitis†. Oral dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) PO every 8 to 12 hours for 2 to 3 weeks. Generally, 2 weeks is appropriate for most patients; immunocompromised patients may require a longer duration.

Intravenous dosage Adults 3.5 to 4 mg/kg/dose (trimethoprim component) IV every 8 to 12 hours for 2 to 3 weeks. Generally, 2 weeks is appropriate for most patients; immunocompromised patients may require a longer duration. For surgical infection prophylaxis†. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO as single dose 1 hour before transrectal biopsy of the prostate or 320 mg trimethoprim/1600 mg sulfamethoxazole PO as single dose 1 to 3 hours before transurethral resection of the prostate.

No intraoperative redosing and a duration of prophylaxis less than 24 hours for most procedures are recommended by clinical practice guidelines. Clinical practice guidelines recommend sulfamethoxazole; trimethoprim for urologic procedures involving lower tract instrumentation with risk factors for infection, including transrectal prostate biopsy.

For the treatment of CNS infections†, including meningitis†, brain abscess†, subdural empyema†, spinal epidural abscess†, and septic thrombosis of the cavernous or dural venous sinus†. Intravenous dosage Adults 10 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours as an alternative therapy for bacterial meningitis caused by E.

coli, L. monocytogenes, or methicillin-resistant Staphylococcus aureus (MRSA). Treat for 10 to 14 days for meningitis due to MRSA and at least 21 days for infections due to L. monocytogenes or gram-negative bacilli. For other MRSA CNS infections, including brain abscess, subdural empyema, spinal epidural abscess, and septic thrombosis of the cavernous or dural venous sinus, 5 mg/kg/dose IV every 8 to 12 hours for 4 to 6 weeks.

Oral rifampin may be added. Infants, Children, and Adolescents 2 months to 17 years 10 to 20 mg/kg/day (trimethoprim component) IV divided every 6 to 12 hours (Max: 960 mg trimethoprim/day) as an alternative therapy for bacterial meningitis caused by E. coli, L. monocytogenes, or methicillin-resistant Staphylococcus aureus (MRSA).

Treat for 10 to 14 days for meningitis due to MRSA and at least 21 days for infections due to L. monocytogenes or gram-negative bacilli. Treat for 4 to 6 weeks for brain abscess, subdural empyema, spinal epidural abscess, or septic thrombosis of the cavernous or dural venous sinus.

For the treatment of mastitis†. Oral dosage Adults 160 to 320 mg trimethoprim/800 to 1,600 mg sulfamethoxazole PO twice daily for 10 to 14 days. For the treatment of peritoneal dialysis-related peritonitis† and peritoneal dialysis catheter-related infection†. For the treatment of peritoneal dialysis-related peritonitis†.

Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 21 to 28 days. Infants, Children, and Adolescents 2 months to 17 years 5 to 10 mg/kg/dose (trimethoprim component) PO every 24 hours (Max: 80 mg trimethoprim/400 mg sulfamethoxazole/day) for 21 days.

1. For the treatment of peritoneal dialysis catheter-related infection†.
2. Oral dosage Adults 80 mg trimethoprim/400 mg sulfamethoxazole PO every 24 hours to 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 14 to 21 days.
3. Infants, Children, and Adolescents 2 months to 17 years 5 to 10 mg/kg/dose (trimethoprim component) PO every 24 hours (Max: 80 mg trimethoprim/400 mg sulfamethoxazole/day) for 14 to 28 days.

For the treatment of brucellosis†. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours in combination with doxycycline for 6 to 8 weeks is recommended as an alternative therapy. For serious infections or complications (i.e., endocarditis, meningitis, and osteomyelitis), the addition of streptomycin or gentamicin for the first 14 to 21 days of therapy is recommended.

• Infants, Children, and Adolescents 2 months to 17 years 8 to 12 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 6 to 8 weeks.
• Give in combination with rifampin or doxycycline (pediatric patients older than 8 years) to reduce the incidence of relapse.

For serious infections or complications (i.e., endocarditis, meningitis, and osteomyelitis), the addition of streptomycin or gentamicin for the first 14 to 21 days of therapy is recommended. For the treatment of Q fever†. Oral dosage Adults Doxycycline is the treatment of choice in adults; however, 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours throughout pregnancy is recommended for all pregnant women.

Children and Adolescents 8 to 17 years Doxycycline is the treatment of choice. Infants and Children 2 months to 7 years 4 mg/kg/dose (trimethoprim component) PO every 12 hours (Max: 160 mg trimethoprim/800 mg sulfamethoxazole/dose) for 14 days. Trimethoprim/sulfamethoxazole may be considered as an alternative therapy to doxycycline in children with mild or uncomplicated illness or as an option in patients who remain febrile after a 5-day course of doxycycline.

Children with high-risk criteria (e.g., hospitalized or who have severe illness, children with preexisting heart valvulopathy, immunocompromised children, or children with delayed Q fever diagnosis who have experienced illness for more than 14 days without resolution of symptoms) should receive doxycycline treatment for 14 days.

For secondary cystoisosporiasis prophylaxis† (i.e., long-term suppressive therapy†) in persons with HIV. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times weekly, or alternatively, 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 320 mg trimethoprim/1,600 mg sulfamethoxazole PO 3 times weekly in patients with CD4 count less than 200 cells/mm3.

Discontinuation may be considered in patients without evidence of active infection who have sustained increase in CD4 count to more than 200 cells/mm3 for more than 6 months in response to antiretroviral therapy. Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO 3 times weekly, or alternatively, 160 mg trimethoprim/800 mg sulfamethoxazole PO once daily or 320 mg trimethoprim/1,600 mg sulfamethoxazole PO 3 times weekly in patients with CD4 count less than 200 cells/mm3.

Discontinuation may be considered in patients without evidence of active infection who have sustained increase in CD4 count to more than 200 cells/mm3 for more than 6 months in response to antiretroviral therapy. Infants and Children 2 months to 12 years 2.5 mg/kg/dose (trimethoprim component) PO twice daily 3 times weekly (Max: 160 mg trimethoprim/day) in patients with severe immunosuppression (CDC immunologic category 3).

Discontinuation may be considered in patients without evidence of active infection who have sustained improvement in immunologic status (CDC immunologic category 1 or 2) for longer than 6 months in response to ART. For chronic typhoid carriage eradication†.

1. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 6 weeks.
2. For the treatment of bartonellosis†, including uncomplicated Oroya fever†.
3. Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours for 14 days as second-line therapy.
4. Infants, Children, and Adolescents 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 14 days as second-line therapy.

For the treatment of plague† infection. For the treatment of bubonic or pharyngeal plague†. Oral dosage Adults 5 mg/kg/dose (trimethoprim component) PO every 8 hours for 10 to 14 days as an alternative therapy. Monotherapy is recommended for stable patients with naturally occurring plague, although dual therapy can be considered for patients with large buboes.

Use dual therapy with 2 distinct classes of antimicrobials for initial treatment of naturally occurring plague in pregnant patients and patients infected after intentional release of Y. pestis. Infants, Children, and Adolescents 2 months to 17 years 5 mg/kg/dose (trimethoprim component) PO every 8 hours for 10 to 14 days as an alternative therapy.

Monotherapy is recommended for stable patients with naturally occurring plague, although dual therapy can be considered for patients with large buboes. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients infected after intentional release of Y.

pestis. Intravenous dosage Adults 5 mg/kg/dose (trimethoprim component) IV every 8 hours for 10 to 14 days as an alternative therapy. Monotherapy is recommended for stable patients with naturally occurring plague, although dual therapy can be considered for patients with large buboes. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment of naturally occurring plague in pregnant patients and patients infected after intentional release of Y.

Bactrim (Trimethoprim/Sulfamethoxazole) antibiotic, What you need to know

pestis. Infants, Children, and Adolescents 2 months to 17 years 5 mg/kg/dose (trimethoprim component) IV every 8 hours for 10 to 14 days as an alternative therapy. Monotherapy is recommended for stable patients with naturally occurring plague, although dual therapy can be considered for patients with large buboes.

Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients infected after intentional release of Y. pestis. For the treatment of pneumonic or septicemic plague†. Oral dosage Adults 5 mg/kg/dose (trimethoprim component) PO every 8 hours for 10 to 14 days as an alternative therapy.

Monotherapy can be considered for mild-to-moderate disease in patients with naturally occurring plague. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment of naturally occurring plague in pregnant patients, patients with severe disease, and patients infected after intentional release of Y.

pestis. Infants, Children, and Adolescents 2 months to 17 years 5 mg/kg/dose (trimethoprim component) PO every 8 hours for 10 to 14 days as an alternative therapy. Monotherapy can be considered for mild-to-moderate disease in patients with naturally occurring plague. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients with severe disease and patients infected after intentional release of Y.

pestis. Intravenous dosage Adults 5 mg/kg/dose (trimethoprim component) IV every 8 hours for 10 to 14 days as an alternative therapy. Monotherapy can be considered for mild-to-moderate disease in patients with naturally occurring plague. Use dual therapy with 2 distinct classes of antimicrobials for initial treatment of naturally occurring plague in pregnant patients, patients with severe disease, and patients infected after intentional release of Y.

• Pestis. Infants, Children, and Adolescents 2 months to 17 years 5 mg/kg/dose (trimethoprim component) IV every 8 hours for 10 to 14 days as an alternative therapy.
• Monotherapy can be considered for mild-to-moderate disease in patients with naturally occurring plague.
• Use dual therapy with 2 distinct classes of antimicrobials for initial treatment in patients with severe disease and patients infected after intentional release of Y.

pestis. For plague prophylaxis†. For pre-exposure prophylaxis†. Oral dosage Adults 5 mg/kg/dose (trimethoprim component) PO every 12 hours until 48 hours after the last perceived exposure as an alternative therapy. Infants, Children, and Adolescents 2 months to 17 years 5 mg/kg/dose (trimethoprim component) PO every 12 hours until 48 hours after the last perceived exposure as an alternative therapy.

1. For postexposure prophylaxis†.
2. Oral dosage Adults 5 mg/kg/dose (trimethoprim component) PO every 12 hours for 7 days as an alternative therapy.
3. Infants, Children, and Adolescents 2 months to 17 years 5 mg/kg/dose (trimethoprim component) PO every 12 hours for 7 days as an alternative therapy.
4. For secondary salmonellosis prophylaxis† (i.e., long-term suppressive therapy†) in persons living with HIV.

Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours in persons with recurrent bacteremia or gastroenteritis with a CD4 count of less than 200 cells/mm3 and severe diarrhea as an alternative. Discontinuation may be considered after resolution of infection in persons with a response to antiretroviral therapy with sustained viral suppression and CD4 count more than 200 cells/mm3.

Adolescents 160 mg trimethoprim/800 mg sulfamethoxazole PO every 12 hours in persons with recurrent bacteremia or gastroenteritis with a CD4 count of less than 200 cells/mm3 and severe diarrhea as an alternative. Discontinuation may be considered after resolution of infection in persons with a response to antiretroviral therapy with sustained viral suppression and CD4 count more than 200 cells/mm3.

For the treatment of invasive vibriosis†. Oral dosage Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) in combination with gentamicin for 7 to 14 days.

Intravenous dosage Infants, Children, and Adolescents 2 months to 17 years 8 to 10 mg/kg/day (trimethoprim component) IV divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) in combination with gentamicin for 7 to 14 days. For the treatment of small intestinal bacterial overgrowth†.

Oral dosage Adults 160 mg trimethoprim/800 mg sulfamethoxazole PO twice daily for 7 to 10 days. Children and Adolescents 8 to 10 mg/kg/day (trimethoprim component) PO divided every 12 hours (Max: 320 mg trimethoprim/1,600 mg sulfamethoxazole/day) for 7 to 10 days.

How does sulfamethoxazole make you feel?

Nausea, vomiting, diarrhea, and loss of appetite may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects.

• Many people using this medication do not have serious side effects.
• Tell your doctor right away if you have any serious side effects, including: muscle weakness, mental/mood changes, signs of kidney problems (such as change in the amount of urine, blood in the urine ), extreme drowsiness, signs of low blood sugar (such as sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet).

Get medical help right away if you have any very serious side effects, including: headache that doesn’t go away, neck stiffness, seizures, slow/irregular heartbeat. This medication may rarely cause serious (possibly fatal) allergic reactions and other side effects such as a severe peeling skin rash (such as Stevens-Johnson syndrome), blood disorders (such as agranulocytosis, aplastic anemia ), liver damage, or lung injury,

If you notice any of the following, get medical help right away: sore throat or fever that doesn’t go away, cough that doesn’t go away, nausea/vomiting that doesn’t stop, skin rash / blisters, itching /swelling (especially of the face/ tongue /throat), new or worsening lymph node swelling, paleness, joint pain /aches, trouble breathing, easy bleeding/bruising, yellowing eyes or skin, unusual fatigue, dark urine,

This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn’t stop, abdominal or stomach pain /cramping, blood / mucus in your stool.

1. If you have these symptoms, do not use anti- diarrhea or opioid products because they may make symptoms worse.
2. Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection,
3. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

What does sulfamethoxazole do to the body?

Proper Use – Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects. Sulfamethoxazole and trimethoprim combination is best taken with a full glass (8 ounces) of water.

Several additional glasses of water should be taken every day, unless otherwise directed by your doctor. Drinking extra water will help to prevent some unwanted effects (eg, crystals in the urine). For patients taking the oral liquid, use a specially marked measuring spoon or other device to measure each dose accurately.

The average household teaspoon may not hold the right amount of liquid. To help clear up your infection completely, keep using this medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop taking this medicine too soon, your symptoms may return.

Can I eat dairy with sulfamethoxazole?

How To Use – Take this medication by mouth, as directed by your doctor, with a full glass of water (8 ounces / 240 milliliters). If stomach upset occurs, take with food or milk. Drink plenty of fluids while taking this medication to lower the unlikely risk of kidney stones forming, unless your doctor advises you otherwise.

Dosage is based on your medical condition and response to treatment. For the best effect, take this antibiotic at evenly spaced times. To help you remember, take this medication at the same time(s) every day. Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days.

Stopping it too early may allow bacteria to continue to grow, which may result in a relapse of the infection. Tell your doctor if your condition persists or worsens.

What are the unwanted effects of sulfamethoxazole?

What side effects may I notice from receiving this medication? – Side effects that you should report to your care team as soon as possible:

Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat Aplastic anemia—unusual weakness or fatigue, dizziness, headache, trouble breathing, increased bleeding or bruising, fever, chills, cough, or sore throat Dry cough, shortness of breath or trouble breathing High potassium level—muscle weakness, fast or irregular heartbeat Liver injury— right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue Low blood sugar (hypoglycemia)—tremors or shaking, anxiety, sweating, cold or clammy skin, confusion, dizziness, rapid heartbeat Low sodium level—muscle weakness, fatigue, dizziness, headache, confusion Rash, fever, and swollen lymph nodes Redness, blistering, peeling, or loosening of the skin, including inside the mouth Severe diarrhea, fever Small, pus-filled bumps on skin Unusual vaginal discharge, itching, or odor

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

Loss of appetite Nausea Vomiting

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Is sulfamethoxazole hard on the liver?

Hepatotoxicity – TMP-SMZ causes a characteristic idiosyncratic liver injury that has features of drug-allergy or hypersensitivityand that resembles the injury attributable to the sulfonamides. The typical onset is sudden development of fever and rash followed by jaundice within a few days or weeks of starting the medication.

• Eosinophilia or atypical lymphocytosis are also common.
• The pattern of injury is typically cholestatic or mixed and can be complicated and prolonged.
• As with other sulfonamides, TMP-SMZ has been linked to cases of hepatocellular injury that can be severe and lead to acute liver failure.
• In most recent case series, TMP-SMZ has ranked within the top 5 to 10 causes of drug induced, idiosyncratic fulminant hepatic failure.

However, most cases resolve rapidly, usually within 2 to 4 weeks unless cholestasis is severe. TMP-SMZ can also cause mild elevations in ALT levels that do not proceed to more severe liver injury or jaundice, and may be accompanied by hepatic granulomas.

Trimethoprim by itself is also capable of causing idiosyncratic, clinically apparent acute liver injury. The injury usually arises after 2 to 12 weeks of therapy and the typical pattern of serum enzyme elevations is mixed or cholestatic. Immunoallergic features are not common, which separates the typical hepatotoxity of trimethoprim from that of sulfamethazole, the sulfonamide component of TMP-SMZ.

In several instances, patients who have developed clinically apparent liver injury due to TMP-SMZ, have re-developed symptoms and laboratory abnormalities when treated with trimethoprim alone.

Is it OK to eat yogurt while on antibiotics?

Eat Fermented Foods – Certain foods can also help restore the gut microbiota after damage caused by antibiotics. Fermented foods are produced by microbes and include yogurt, cheese, sauerkraut, kombucha and kimchi, among others. They contain a number of healthy bacterial species, such as Lactobacilli, which can help restore the gut microbiota to a healthy state after antibiotics.

Studies have shown that people who eat yogurt or fermented milk have higher amounts of Lactobacilli in their intestines and lower amounts of disease-causing bacteria, such as Enterobacteria and Bilophila wadsworthia ( 18, 19, 20 ). Kimchi and fermented soybean milk have similar beneficial effects and can help cultivate healthy bacteria in the gut, such as Bifidobacteria ( 21, 22 ).

Therefore, eating fermented foods may help improve gut health after taking antibiotics. Other studies have also found that fermented foods may be beneficial during antibiotic treatment. Some of these have shown that taking either normal or probiotic-supplemented yogurt can reduce diarrhea in people taking antibiotics ( 23, 24, 25 ).

Why can’t I be in the sun while taking sulfamethoxazole?

SMZ-TPM Side Effects – If your child has an upset stomach when taking this medication, it may be helpful to give food or milk with each dose. Limit your child’s exposure to the sun while he or she is taking this medication. Sulfamethoxazole with trimethoprim can also cause sensitivity to sunlight.

If your child must be outside for a long period, he or she should wear protective clothing, such as a hat and sunglasses, and use a sunscreen with a sun protection factor (SPF) of at least 15. Make sure the sunscreen your child uses does not contain PABA oil. PABA can interfere with the action of sulfamethoxazole with trimethoprim.

You may notice that your child has less of an appetite than usual. Sometimes, people taking this medication experience headaches, nausea, or vomiting. Tell your transplant doctor or transplant coordinator right away if your child develops any of these rare SMZ-TPM side effects:

Skin rash Difficulty breathing Itching Hives Chills Fever Sore throat Aching of joints or muscles Easy bleeding or bruising Yellowing of the eyes or skin Peeling skin Tiredness

How much water should I drink with sulfamethoxazole?

Proper Use – Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects. Sulfamethoxazole and trimethoprim combination is best taken with a full glass (8 ounces) of water.

Several additional glasses of water should be taken every day, unless otherwise directed by your doctor. Drinking extra water will help to prevent some unwanted effects (eg, crystals in the urine). For patients taking the oral liquid, use a specially marked measuring spoon or other device to measure each dose accurately.

The average household teaspoon may not hold the right amount of liquid. To help clear up your infection completely, keep using this medicine for the full time of treatment, even if you begin to feel better after a few days. If you stop taking this medicine too soon, your symptoms may return.

What happens if you accidentally take 2 sulfamethoxazole?

It is estimated that 5,000 deaths are caused every year in England because antibiotics no longer work for some infections and this figure is set to rise with experts predicting that in just over 30 years antibiotic resistance will kill more people than cancer and diabetes combined.

Antibiotics are used to treat or prevent some types of bacterial infection. They work by killing bacteria or preventing them from reproducing and spreading. But they don’t work for everything. When it comes to antibiotics, take your doctor’s advice. Antibiotics don’t work for viral infections such as colds and flu, and most coughs and sore throats.

Many mild bacterial infections also get better on their own without using antibiotics. Taking antibiotics when you don’t need them puts you and your family at risk of a longer and more severe illness. When antibiotics are used Antibiotics may be used to treat bacterial infections that: •are unlikely to clear up without antibiotics •could infect others unless treated •could take too long to clear without treatment •carry a risk of more serious complications People at a high risk of infection may also be given antibiotics as a precaution, known as antibiotic prophylaxis.

• How do I take antibiotics? Take antibiotics as directed on the packet or the patient information leaflet that comes with the medication, or as instructed by your GP or pharmacist.
• Doses of antibiotics can be provided in several ways: •Oral antibiotics – tablets, capsules or a liquid that you drink, which can be used to treat most types of mild to moderate infections in the body •Topical antibiotics – creams, lotions, sprays or drops, which are often used to treat skin infections •Injections of antibiotics – these can be given as an injection or infusion through a drip directly into the blood or muscle, and are usually reserved for more serious infections It’s essential to take antibiotics as prescribed by your healthcare professional.

Missing a dose of antibiotics If you forget to take a dose of your antibiotics, take that dose as soon as you remember and then continue to take your course of antibiotics as normal. But if it’s almost time for the next dose, skip the missed dose and continue your regular dosing schedule.

Don’t take a double dose to make up for a missed one. There’s an increased risk of side effects if you take two doses closer together than recommended. Accidentally taking an extra dose Accidentally taking one extra dose of your antibiotic is unlikely to cause you any serious harm. But it will increase your chances of experiencing side effects, such as pain in your stomach, diarrhoea, and feeling or being sick.

If you accidentally take more than one extra dose of your antibiotic, are worried or experiencing severe side effects, speak to your GP or call NHS 111 as soon as possible. Side effects of antibiotics As with any medication, antibiotics can cause side effects.

Most antibiotics don’t cause problems if they’re used properly and serious side effects are rare. The most common side effects include: •being sick •feeling sick •bloating and indigestion •diarrhoea Some people may have an allergic reaction to antibiotics, especially penicillin and a type called cephalosporins.

In very rare cases, this can lead to a serious allergic reaction (anaphylaxis), which is a medical emergency. Considerations and interactions Some antibiotics aren’t suitable for people with certain medical conditions, or women who are pregnant or breastfeeding.

You should only ever take antibiotics prescribed for you – never “borrow” them from a friend or family member. Some antibiotics can also react unpredictably with other medications, such as the oral contraceptive pill and alcohol. It’s important to read the information leaflet that comes with your medication carefully and discuss any concerns with your pharmacist or GP.

Read more about: •things to consider before taking antibiotics •how antibiotics interact with other medicines Types of antibiotics There are hundreds of different types of antibiotics, but most of them can be broadly classified into six groups. These are outlined below.

Penicillins (such as penicillin and amoxicillin) – widely used to treat a variety of infections, including skin infections, chest infections and urinary tract infections •Cephalosporins (such as cephalexin) – used to treat a wide range of infections, but some are also effective for treating more serious infections, such as septicaemia and meningitis •Aminoglycosides (such as gentamicin and tobramycin) – tend to only be used in hospital to treat very serious illnesses such as septicaemia, as they can cause serious side effects, including hearing loss and kidney damage; they’re usually given by injection, but may be given as drops for some ear or eye infections •Tetracyclines (such as tetracycline and doxycycline) – can be used to treat a wide range of infections, but are commonly used to treat moderate to severe acne and rosacea •Macrolides (such as erythromycin and clarithromycin) – can be particularly useful for treating lung and chest infections, or an alternative for people with a penicillin allergy, or to treat penicillin-resistant strains of bacteria •Fluoroquinolones (such as ciprofloxacin and levofloxacin) – broad-spectrum antibiotics that can be used to treat a wide range of infections Antibiotic resistance Both the NHS and health organisations across the world are trying to reduce the use of antibiotics, especially for conditions that aren’t serious.

The overuse of antibiotics in recent years means they’re becoming less effective and has led to the emergence of “superbugs”. These are strains of bacteria that have developed resistance to many different types of antibiotics, including: •methicillin-resistant Staphylococcus aureus (MRSA) •Clostridium difficile (C.