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Cotrimoxazole: Brands, Price & Uses in Bangladesh
Cotrimoxazole is a fixed-dose combination antibacterial (sulfamethoxazole and trimethoprim, also known as co-trimoxazole/SMX-TMP) that acts synergistically to sequentially block two steps in…
About Cotrimoxazole
Indications of Cotrimoxazole
Cotrimoxazole is a fixed-dose combination antibacterial (sulfamethoxazole and trimethoprim, also known as co-trimoxazole/SMX-TMP) that acts synergistically to sequentially block two steps in bacterial folic acid synthesis. Indications vary in the strength of supporting evidence:
FDA-Approved / Established Uses
- Urinary tract infections caused by susceptible strains of E. coli, Klebsiella, Proteus, and other susceptible organisms
- Acute otitis media in children (when caused by susceptible strains)
- Acute exacerbations of chronic bronchitis in adults
- Shigellosis (bacillary dysentery) caused by susceptible Shigella strains
- Traveler's diarrhea caused by susceptible strains of enterotoxigenic E. coli
- Pneumocystis jirovecii pneumonia (PCP) — both treatment and first-line prophylaxis, particularly in immunocompromised patients (e.g., HIV/AIDS, transplant recipients)
Guideline-Supported / Adjunct Uses
- Toxoplasmosis prophylaxis in selected immunocompromised patients (as part of guideline-based regimens)
- Nocardiosis, as part of combination or alternative therapy where guideline-supported
Cotrimoxazole should be used only for infections proven or strongly suspected to be caused by susceptible bacteria, as confirmed where possible by culture and susceptibility testing, to reduce the development of drug-resistant organisms.
Dosage & Administration of Cotrimoxazole
Cotrimoxazole dosing is indication-specific and is expressed in terms of the trimethoprim (TMP) component. Representative regimens are summarized below; the prescribing physician's instructions should always take precedence.
| Indication | Adult Dose | Pediatric Dose (≥2 months) |
|---|---|---|
| Urinary tract infection | 1 double-strength (DS, 800/160 mg) tablet every 12 hours for 10–14 days | 8 mg/kg/day TMP + 40 mg/kg/day SMX, divided every 12 hours |
| Shigellosis | 1 DS tablet every 12 hours for 5 days | Same weight-based regimen as above, for 5 days |
| Traveler's diarrhea | 1 DS tablet every 12 hours for 5 days | Not routinely used; physician guidance required |
| Acute exacerbation of chronic bronchitis | 1 DS tablet every 12 hours for 14 days | Not applicable |
| Acute otitis media | Not typically indicated | 8 mg/kg/day TMP + 40 mg/kg/day SMX, divided every 12 hours for 10 days |
| Pneumocystis jirovecii pneumonia (treatment) | 15–20 mg/kg/day TMP + 75–100 mg/kg/day SMX, in divided doses every 6–8 hours for 14–21 days | Same weight-based high-dose regimen, per physician/specialist guidance |
| Pneumocystis jirovecii pneumonia (prophylaxis) | 1 DS tablet once daily, or 1 single-strength tablet once daily | 150 mg/m²/day TMP component, divided every 12 hours, on 3 days per week, per physician guidance |
Renal impairment: For creatinine clearance 15–30 mL/min, half the usual dose is recommended; Cotrimoxazole is not recommended when creatinine clearance is below 15 mL/min unless the patient is on dialysis and dosing is directed by a physician.
Cotrimoxazole tablets should be taken with a full glass of water, and adequate fluid intake should be maintained throughout treatment to reduce the risk of crystalluria. It may be taken with or without food; taking it with food may reduce stomach upset.
Antibiotic stewardship: Take Cotrimoxazole exactly as prescribed by your physician; do not stop, extend, skip doses, or share this medicine with others without medical advice, even if symptoms improve before the course is completed.
Side Effects of Cotrimoxazole
Most adverse effects associated with Cotrimoxazole are mild to moderate, but some serious reactions require prompt medical attention.
Common
- Nausea, vomiting
- Loss of appetite
- Diarrhea
- Skin rash
- Headache
Less Common / Serious (see Precautions and Warnings for detail)
- Severe hypersensitivity reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis
- Blood disorders (agranulocytosis, aplastic anemia, thrombocytopenia, hemolytic anemia) with prolonged use
- Hyperkalemia, particularly in renal impairment or elderly patients
- Hepatotoxicity, including cholestatic jaundice and fulminant hepatic necrosis (rare)
- Photosensitivity reactions
- Clostridioides difficile-associated diarrhea/colitis
Contraindications of Cotrimoxazole
Cotrimoxazole is contraindicated in:
- Patients with known hypersensitivity to sulfonamides, trimethoprim, or any component of Cotrimoxazole, or with a history of drug-induced immune thrombocytopenia with either component.
- Patients with megaloblastic anemia due to documented folate deficiency.
- Infants under 2 months of age.
- Pregnant women at term and during labor and delivery, due to the risk of kernicterus in the newborn.
- Patients with severe hepatic damage.
- Patients with severe renal insufficiency in whom renal function cannot be monitored.
- Patients receiving concurrent dofetilide therapy.
Frequently Asked Questions about Cotrimoxazole
What is Cotrimoxazole used for?
Cotrimoxazole is a combination antibiotic used to treat susceptible bacterial infections such as urinary tract infections, certain respiratory tract infections, traveler's diarrhea, and shigellosis, and is also used for the treatment and prevention of Pneumocystis jirovecii pneumonia, particularly in immunocompromised patients, as directed by a physician.
How should I take Cotrimoxazole?
Cotrimoxazole should be taken exactly as prescribed, with a full glass of water and adequate fluid intake, with or without food. Complete the full course even if you feel better before finishing it, unless your physician advises otherwise.
Can I take Cotrimoxazole during pregnancy?
Cotrimoxazole should generally be avoided during pregnancy, especially in the first trimester and at term, due to potential risks to the fetus and newborn. It should be used only if clearly needed, no safer alternative exists, and your physician determines the benefit outweighs the risk. It is contraindicated near delivery.
Who should not take Cotrimoxazole?
Cotrimoxazole should not be taken by anyone with a known allergy to sulfonamides or trimethoprim, infants under 2 months of age, people with megaloblastic anemia due to folate deficiency, those with severe liver or kidney impairment, or pregnant women at term/near delivery.
What are the common side effects of Cotrimoxazole?
The most common side effects of Cotrimoxazole include nausea, vomiting, loss of appetite, skin rash, and headache. Contact your physician immediately if you develop a rash, fever, unusual bruising/bleeding, or yellowing of the skin or eyes, as these can signal rare but serious reactions.
What should I do if I miss a dose or take too much Cotrimoxazole?
If you miss a dose of Cotrimoxazole, take it as soon as you remember unless it is almost time for the next dose, in which case skip the missed dose — do not double up. If you suspect an overdose of Cotrimoxazole, seek immediate medical attention or contact a poison control center right away.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.