What is trimethoprim-sulfamethoxazole. How does this antibiotic work. What are the common uses of trimethoprim-sulfamethoxazole. What are the recommended dosages for different conditions. What are the potential side effects and precautions to consider. How to take trimethoprim-sulfamethoxazole safely and effectively.

Understanding Trimethoprim-Sulfamethoxazole: An Antibiotic Powerhouse

Trimethoprim-sulfamethoxazole, also known as co-trimoxazole or TMP/SMX, is a potent antibiotic combination used to combat various bacterial infections. This FDA-approved medication, available as the generic form of Bactrim, combines two antibiotics that work synergistically to inhibit bacterial growth and resolve infections effectively.

How does trimethoprim-sulfamethoxazole work? The medication targets a specific chemical crucial for bacterial growth. By halting the production of this essential component, the antibiotic effectively stops bacteria from multiplying, allowing the body’s immune system to eliminate the infection.

Common Uses of Trimethoprim-Sulfamethoxazole: From UTIs to Pneumonia

Healthcare providers prescribe trimethoprim-sulfamethoxazole for a wide range of bacterial infections. Some of the most common conditions treated with this antibiotic include:

• Urinary tract infections (UTIs), including those caused by Escherichia coli (E. coli)
• Otitis media (middle ear infections) in children
• Traveler’s diarrhea
• Shigellosis or shigella (bacillary dysentery)
• Chronic bronchitis flare-ups
• Acne vulgaris
• Methicillin-resistant Staphylococcus aureus (MRSA) infections
• Pneumocystis jiroveci pneumonia or pneumocystis carinii pneumonia (PCP)

Is trimethoprim-sulfamethoxazole effective against viral infections? It’s important to note that this antibiotic, like all others, is not effective against viral infections such as the common cold or influenza. Using antibiotics for viral conditions can contribute to antibiotic resistance, a growing concern in modern medicine.

Dosage Guidelines: Tailoring Treatment to Specific Conditions

The appropriate dosage of trimethoprim-sulfamethoxazole varies depending on the condition being treated, its severity, and individual patient factors. Healthcare providers carefully determine the optimal dosage for each patient. Here are some common dosing guidelines for adults and children over two months of age:

For Urinary Tract Infections and Shigellosis:

800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 5 days (shigellosis) or 14 days (UTIs)

For Chronic Bronchitis Flare-ups:

800 mg/160 mg every 12 hours for 10-14 days

For Pneumocystis Pneumonia Treatment:

75-100 mg of sulfamethoxazole and 15-20 mg of trimethoprim per kilogram of body weight, taken every 6 hours for 14-21 days

For Pneumocystis Pneumonia Prevention:

800 mg/160 mg once daily

For Traveler’s Diarrhea:

800 mg/160 mg every 12 hours for five days

For Children with Shigellosis, Middle Ear Infections, or UTIs:

40 mg/8 mg every 12 hours for 5 days (shigellosis) or 10 days (acute otitis media and UTIs)

Why is it crucial to complete the full course of antibiotics? Even if symptoms improve after a few days, it’s essential to finish the entire prescribed course of trimethoprim-sulfamethoxazole. Stopping treatment prematurely may allow some bacteria to survive, potentially leading to a recurrence of the infection or the development of antibiotic-resistant strains.

Administration Forms: Tablets and Liquid Options

Trimethoprim-sulfamethoxazole is available in two primary forms: tablets and liquid suspension. Both are typically administered orally. The choice between these forms often depends on patient preference, age, and ability to swallow tablets.

How should trimethoprim-sulfamethoxazole be taken? Always follow your healthcare provider’s instructions carefully. If you’re using the liquid form, shake the bottle well before each dose to ensure proper mixing of the medication. For both forms, it’s generally recommended to take the antibiotic with a full glass of water to help prevent potential kidney complications.

Potential Side Effects: What to Watch For

Like all medications, trimethoprim-sulfamethoxazole can cause side effects. While not everyone experiences these, it’s important to be aware of potential reactions. Common side effects may include:

• Nausea and vomiting
• Diarrhea
• Loss of appetite
• Skin rash or itching
• Headache
• Dizziness

Are there any serious side effects to be concerned about? While rare, some individuals may experience more severe reactions, such as:

• Severe skin reactions (e.g., Stevens-Johnson syndrome)
• Liver problems
• Blood disorders
• Severe allergic reactions

If you experience any severe or persistent side effects, it’s crucial to contact your healthcare provider immediately.

Precautions and Contraindications: When to Avoid Trimethoprim-Sulfamethoxazole

While trimethoprim-sulfamethoxazole is an effective antibiotic for many conditions, it’s not suitable for everyone. Certain factors may increase the risk of adverse reactions or reduce the medication’s effectiveness.

Who should avoid taking trimethoprim-sulfamethoxazole? This antibiotic may not be appropriate for individuals with:

• Known allergies to sulfa drugs or trimethoprim
• Severe liver or kidney disease
• Certain blood disorders
• Pregnancy (especially during the third trimester) or breastfeeding
• G6PD deficiency

Additionally, trimethoprim-sulfamethoxazole can interact with various medications, including blood thinners, diuretics, and certain diabetes medications. Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking to avoid potential interactions.

Obtaining Trimethoprim-Sulfamethoxazole: Prescription Requirements

Trimethoprim-sulfamethoxazole is a prescription-only medication, meaning it cannot be obtained without a valid prescription from a licensed healthcare provider. This requirement ensures that the antibiotic is used appropriately and helps prevent antibiotic resistance.

Can trimethoprim-sulfamethoxazole be purchased online? While it’s possible to fill a prescription for this antibiotic through online pharmacies, it’s crucial to use only licensed, reputable sources that require a valid prescription. Some individuals may opt for telemedicine consultations to obtain a prescription, which can be a convenient option for those unable to visit a doctor in person.

Antibiotic Resistance: A Growing Concern

The overuse and misuse of antibiotics, including trimethoprim-sulfamethoxazole, contribute to the growing problem of antibiotic resistance. This phenomenon occurs when bacteria evolve to survive the effects of antibiotics, rendering these medications less effective or completely ineffective against certain strains.

How can we help prevent antibiotic resistance? To combat this issue, it’s essential to:

• Only use antibiotics when prescribed by a healthcare provider
• Complete the full course of antibiotics as directed
• Never share antibiotics with others or use leftover antibiotics from previous treatments
• Practice good hygiene to prevent the spread of infections

By using antibiotics responsibly, we can help preserve their effectiveness for future generations.

Special Considerations for Immunocompromised Patients

Trimethoprim-sulfamethoxazole plays a crucial role in treating and preventing certain infections in immunocompromised individuals, such as those with HIV/AIDS or undergoing cancer treatment. For these patients, the medication is particularly important in preventing and treating Pneumocystis jiroveci pneumonia (PCP), a potentially life-threatening lung infection.

Why is PCP prevention critical for immunocompromised patients? PCP can be severe and even fatal in individuals with weakened immune systems. Trimethoprim-sulfamethoxazole, when used prophylactically, significantly reduces the risk of developing this opportunistic infection.

For immunocompromised patients, healthcare providers may prescribe long-term, low-dose trimethoprim-sulfamethoxazole as a preventive measure. The dosage and duration of treatment will depend on the individual’s specific condition and risk factors.

Monitoring and Follow-up: Ensuring Safe and Effective Treatment

When prescribed trimethoprim-sulfamethoxazole, regular monitoring may be necessary to ensure the medication is working effectively and to catch any potential side effects early. This is particularly important for long-term use or in patients with certain risk factors.

What type of monitoring might be required? Depending on the individual case, healthcare providers may recommend:

• Regular blood tests to check kidney and liver function
• Complete blood count to monitor for potential blood disorders
• Urine tests to assess the effectiveness of treatment for urinary tract infections
• Clinical evaluation to monitor symptom improvement

It’s important to attend all scheduled follow-up appointments and to report any new or worsening symptoms promptly to your healthcare provider.

Drug Interactions: Navigating Potential Complications

Trimethoprim-sulfamethoxazole can interact with various medications, potentially altering their effectiveness or increasing the risk of side effects. Understanding these interactions is crucial for safe and effective treatment.

Which medications may interact with trimethoprim-sulfamethoxazole? Some common drugs that may interact include:

• Warfarin and other blood thinners
• Methotrexate
• Phenytoin
• Certain diuretics
• Some oral diabetes medications
• ACE inhibitors

To minimize the risk of drug interactions, always provide your healthcare provider with a complete list of all medications, supplements, and herbal products you’re taking. In some cases, dosage adjustments or alternative treatments may be necessary to avoid potential complications.

Patient Education: Maximizing Treatment Effectiveness

Proper patient education is key to ensuring the safe and effective use of trimethoprim-sulfamethoxazole. Understanding how to take the medication correctly, recognizing potential side effects, and knowing when to seek medical attention can significantly improve treatment outcomes.

What are some important points for patients to remember?

• Take the medication exactly as prescribed, at regular intervals to maintain consistent blood levels
• Complete the full course of treatment, even if symptoms improve before the medication is finished
• Stay well-hydrated while taking trimethoprim-sulfamethoxazole to help prevent kidney-related side effects
• Avoid prolonged sun exposure, as the medication can increase skin sensitivity to sunlight
• Report any unusual symptoms or side effects to your healthcare provider promptly
• Inform all healthcare providers about your use of trimethoprim-sulfamethoxazole, especially before any medical procedures or when starting new medications

By following these guidelines and maintaining open communication with healthcare providers, patients can maximize the benefits of trimethoprim-sulfamethoxazole while minimizing potential risks.

Future Developments: Ongoing Research and Alternatives

As antibiotic resistance continues to be a global health concern, research into new antibiotics and alternative treatments is ongoing. While trimethoprim-sulfamethoxazole remains an effective treatment for many bacterial infections, scientists are exploring new approaches to combat resistant strains and develop more targeted therapies.

What potential alternatives are being researched? Some areas of focus include:

• Novel antibiotic combinations to overcome resistance mechanisms
• Bacteriophage therapy, using viruses that specifically target bacteria
• Immunomodulatory therapies to enhance the body’s natural defenses against infections
• Nanotechnology-based drug delivery systems for more efficient antibiotic treatment

As research progresses, it’s likely that new treatment options will emerge to complement or potentially replace traditional antibiotics like trimethoprim-sulfamethoxazole in certain situations. However, responsible use of current antibiotics remains crucial in preserving their effectiveness and buying time for the development of new treatments.

In conclusion, trimethoprim-sulfamethoxazole is a valuable antibiotic in the treatment of various bacterial infections. Its effectiveness, coupled with proper usage and monitoring, makes it an important tool in modern medicine. As with all medications, it’s essential to use trimethoprim-sulfamethoxazole under the guidance of a healthcare professional, adhering to prescribed dosages and being vigilant for potential side effects or interactions. By doing so, patients can benefit from its therapeutic effects while minimizing risks and contributing to the broader effort to combat antibiotic resistance.

Uses, Side Effects, Dosages, Contra-indications, Warnings, Interactions & More

Bacterial infections sometimes require pharmaceutical treatment, such as antibiotic medications. One common medication prescribed by doctors is trimethoprim-sulfamethoxazole (sometimes called co-trimoxazole or TMP/SMX), the generic form of Bactrim.

Trimethoprim with sulfamethoxazole works by destroying bacteria in the body, which can alleviate bacterial infections.

As with any medication, trimethoprim-sulfamethoxazole is not for everyone. Your doctor will determine if it’s the right treatment based on your infection, health history, and current medications, among other things.

To help you be an informed patient—and to make prescription medicine more transparent—this article will address what trimethoprim-sulfamethoxazole is, what it’s used for, potential side effects, and how to take it.

Talk to a doctor online

Refill medications and get certain necessary prescriptions.

Start now

What Is Trimethoprim-sulfamethoxazole?

Trimethoprim-sulfamethoxazole, or generic Bactrim, is an FDA-approved prescription antibiotic medication.

A combination of two types of antibiotics, TMP/SMX treats common bacterial infections, including serious types of pneumonia called pneumocystis jiroveci pneumonia and pneumocystis carinii pneumonia (PCP). 

Trimethoprim-sulfamethoxazole works by decreasing the bacteria infecting a person’s body. The two active ingredients work together to prevent a chemical many bacteria need to grow.

Once production of that chemical ceases, the bacteria also stops growing, which can help resolve an infection.

What Is It Used For? 

Trimethoprim-sulfamethoxazole is an antibacterial drug used to treat infectious diseases in the body caused by bacteria. Doctors commonly prescribe it for: 

• Urinary tract infections (UTIs), including those caused by Escherichia coli (e.coli)
• Otitis media (middle ear infections) in children
• Traveler’s diarrhea 
• Shigellosis or shigella (bacillary dysentery)
• Chronic bronchitis flare-ups
• Acne vulgaris
• Methicillin-resistant staphylococcus aureus (also known as MRSA), a type of staph infection
• Pneumocystis jiroveci pneumonia or pneumocystis carinii pneumonia (two serious types of pneumonia in people with compromised immune systems, such as those undergoing treatment for cancer or people living with HIV)

Antibiotics, including trimethoprim-sulfamethoxazole, don’t work for viral infections such as the common cold and influenza.

Additionally, taking antibiotics too much or to try to prevent disease can result in antibiotic resistance. This is when bacteria develop a way to outlive medications meant to kill them, making the treatment obsolete.

Can You Get Trimethoprim-sulfamethoxazole Online?

Since trimethoprim-sulfamethoxazole is a prescription antibiotic medication, you need a healthcare provider’s prescription to get it. 

You can take your prescription to an online pharmacy to purchase the drug online; however, it’s important that you only get medication from a licensed pharmacy that requires a prescription from a doctor. 

If you don’t want to see a doctor in person or you don’t have access to one, you can chat with a K doctor, who may prescribe an antibiotic based on your symptoms.

What Forms Does Trimethoprim-sulfamethoxazole Come In?

Trimethoprim-sulfamethoxazole comes in two forms: liquid and tablet. It’s generally taken by mouth. Your doctor will instruct you on the best way to take your medication.

Make sure to follow their instructions and finish the course of treatment, even if you start to feel better after a few days. If you don’t take all of the medication, you may not completely kill off the bacteria, and the infection could return.

What Are Common Dosages of Trimethoprim-sulfamethoxazole?

Your doctor will work with you to determine the appropriate dosage of trimethoprim-sulfamethoxazole based on your infection, its severity, and your general health.

Common dosing for adults and children older than two months of age include: 

• For shigellosis or urinary tract infections: 800 milligrams (mg) of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 5 days (for shigellosis) or 14 days (for UTIs)

• For chronic bronchitis flare-ups: 800 mg/160 mg every 12 hours for 10-14 days

• To treat pneumocystis jirovecii pneumonia or pneumocystis carinii pneumonia: The dose varies by weight (usually 75-100 mg of sulfamethoxazole and 15-20 mg of trimethoprim per kilogram of body weight) and is taken every 6 hours for 14-21 days 

• To prevent pneumocystis jirovecii pneumonia or pneumocystis carinii pneumonia: 800 mg/160 mg once daily

• For traveler’s diarrhea: 800 mg/160 mg every 12 hours for five days

• For shigellosis, middle ear infections, or UTIs in children: 40mg/8mg every 12 hours for 5 days (for shigellosis) or 10 days (for acute ear infections and UTIs)

Side Effects of Trimethoprim-sulfamethoxazole

All medications come with a risk of unwanted side effects. Your doctor or pharmacist should give you a heads up about these. The most commonly reported side effects of trimethoprim-sulfamethoxazole are: 

• Nausea
• Vomiting
• Decreased appetite

More rarely, people who take trimethoprim with sulfamethoxazole experience serious side effects. Talk to your doctor right away if you have any of the following: 

• Chest pain, cough, or difficulty breathing 
• Severe diarrhea or stomach pain
• Dark urine or pale stools
• Yellowing skin or eyes
• Skin rash, including purple spots on your skin
• Changes in urination or painful urination
• Lower back or side (flank) pain
• Confusion
• Weakness
• Muscle twitching
• Seizures
• Unusual bleeding or bruising
• Fever
• Muscle pain
• Sore throat

And if you have experience of the below allergic reaction symptoms, call 911 or seek emergency care: 

• Hives or itching
• Swelling in your face or hands
• Swelling or tingling in your throat or mouth 
• Chest tightness
• Difficulty breathing 

How to Take Trimethoprim-sulfamethoxazole

Follow your doctor’s instructions, including how much to take and when, when prescribed trimethoprim-sulfamethoxazole. It’s important, too, to finish your course of treatment even if you begin to feel better. 

To reduce the risk of unwanted side effects, drink a glass of water when you take trimethoprim-sulfamethoxazole and continue to drink water throughout the day. 

If you forget to take trimethoprim-sulfamethoxazole, take it as soon as you remember. But if it’s almost time for your next dose, wait until that time to take a single dose. Don’t take extra to make up for the dose you missed. 

Contraindications

It’s always important to inform your healthcare provider about your medical history. In any of the following situations, be especially sure to talk to your doctor before taking trimethoprim-sulfamethoxazole: 

• Pregnancy: Trimethoprim-sulfamethoxazole can harm unborn babies, so take an effective birth control to prevent pregnancy during your course of treatment. Immediately tell your doctor if you may be pregnant while you’re using trimethoprim-sulfamethoxazole.
• Breastfeeding: This medication can harm babies through breast milk.
• Diabetes: Trimethoprim-sulfamethoxazole can interfere with glucose production and certain oral diabetes medications.
• Anticonvulsant treatment: People taking medications to prevent seizures, such as phenytoin, could be at risk for vitamin B9 (folate, or folic acid) deficiency.
• High potassium (hyperkalemia): TMP/SMX can increase potassium levels in the blood.
• Infants: Clinicians prescribe trimethoprim-sulfamethoxazole for pediatric bacterial infections, but babies under two months of age should not take this medication.

Talk to a doctor online

Refill medications and get certain necessary prescriptions.

Start now

Drug Interactions

Not all medications play nicely together. Sometimes taking trimethoprim-sulfamethoxazole in addition to other drugs can cause serious interactions.

Be sure your doctor knows if you’re currently taking any medications, particularly those below.

• ACE inhibitors
• Blood thinners
• Oral diabetes medication
• Diuretics
• Leucovorin
• Indomethacin
• Anticonvulsants
• Memantine
• Methotrexate
• Pyrimethamine

Warnings

Along with less serious side effects, trimethoprim-sulfamethoxazole can cause more adverse effects, including serious, life-threatening medical problems in some people.

It’s normal to experience some gastrointestinal discomfort on antibiotics, but if you have diarrhea for more than two weeks or an exacerbation of your GI symptoms, talk to your healthcare provider or chat with a K doctor.

Some patients may experience serious skin reactions. If you have any of the following symptoms, talk to a doctor or seek medical care right away: 

• Skin rash 
• Blistering
• Peeling
• Loosening skin 
• Itching 
• Red skin lesions
• Sores
• Ulcers
• White spots in your mouth or lips

In some people, this medication can cause liver problems. Seek medical treatment if you have these symptoms: 

• Darkening urine
• Lightening stool 
• Stomach pain
• Jaundice (yellowing eyes or skin)

People who take higher doses of trimethoprim-sulfamethoxazole, especially for prolonged periods, could be at risk for reduced platelet count. Consult with your doctor if you experience: 

• Black, tarry stools
• Blood in your urine or stool 
• Unusual bleeding

All medications come with a risk of severe allergic reactions, which require immediate emergency medical care. Call a doctor or go to the emergency room if you have any of the following adverse reactions: 

• Itching
• Swelling in your mouth, throat, or tongue
• Difficulty breathing
• Chest pain

Lastly, trimethoprim-sulfamethoxazole can affect certain medical tests. If you need lab work done at the doctor or dentist, tell the provider that you’re taking this antibiotic. 

How K Health Can Help 

Did you know you can access online urgent care with K Health?

Check your symptoms, explore conditions and treatments, and if needed, text with a healthcare provider in minutes.  

K Health’s AI-powered app is HIPAA compliant and is based on 20 years of clinical data.

Frequently Asked Questions

What is trimethoprim-sulfamethoxazole used to treat?

Trimethoprim-sulfamethoxazole is used to treat a variety of bacterial infections, from ear infections, urinary tract infections, and traveler’s diarrhea to more serious infections like pneumonia. If you have a bacterial infection, your doctor will work with you to determine whether trimethoprim-sulfamethoxazole is an appropriate course of treatment.

How long does trimethoprim-sulfamethoxazole stay in your system?

Every drug has a half life, which is the amount of time it takes for the medication to reduce to half of the initial dose. The half life of trimethoprim is about 8-10 hours, and the half life of sulfamethoxazole is about 10 hours.

Should you drink a lot of water when you take trimethoprim-sulfamethoxazole?

Drinking extra water when you take trimethoprim-sulfamethoxazole may help prevent unwanted side effects. Follow your doctor’s instructions, but overall it’s best to take the medication with a full glass of water. And it never hurts to drink water throughout the day to promote hydration.

How long does it take for trimethoprim-sulfamethoxazole to work?

Your body will start to absorb trimethoprim-sulfamethoxazole immediately when you start taking it, and it will start to kill bacteria within about four hours of your first dose. Generally, people start to feel better within a few days of taking trimethoprim-sulfamethoxazole, but it can take up to a few weeks if you have a complicated diagnosis like pneumonia. Even if you start to feel better, follow your doctor’s instructions and continue taking your medication until it’s gone.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

• Bactrim™. (2013).
  https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/017377s068s073lbl.pdf

• Drug Database: Sulfamethoxazole / Trimethoprim. (revised 2020).
  https://clinicalinfo.hiv.gov/en/drugs/sulfamethoxazole-trimethoprim/tablet-tablet-double-strength

• Sulfamethoxazole and Trimethoprim (Oral Route). (updated 2021).
  https://www.mayoclinic.org/drugs-supplements/sulfamethoxazole-and-trimethoprim-oral-route/side-effects/drg-20071899

• Trimethoprim Sulfamethoxazole. (updated 2020).
  https://www.ncbi.nlm.nih.gov/books/NBK513232/

trimethoprim/sulfamethoxazole (TMP/SMX, Bactrim, Septra) – International Association of Providers of AIDS Care

WHAT IS TRIMETHOPRIM/SULFAMETHOXAZOLE?

Trimethoprim/sulfamethoxazole (TMP/SMX) is a combination of two antibiotics: trimethoprim and sulfamethoxazole. It is also known as cotrimoxazole. Its brand names are Bactrim or Septra. TMP/SMX is sold under many other names in different parts of the world.

Antibiotics fight infections caused by bacteria. TMP/SMX is also used to fight infections caused by protozoa and some opportunistic infections (OIs) in people with HIV.

WHY DO PEOPLE WITH HIV TAKE TMP/SMX?

TMP/SMX is used for many bacterial infections. It is effective and inexpensive. Adding TMP/SMX to antiretroviral therapy (ART) reduces death in the first 60 weeks of treatment by 35% according to an African study reported in 2010. Unfortunately, up to one third of the people who take TMP/SMX get an allergic reaction.

Many germs live in our bodies or are common in our surroundings. A healthy immune system can fight them off or keep them under control. However, HIV infection can weaken the immune system. Infections that take advantage of weakened immune defenses are called opportunistic infections (OIs). People with advanced HIV disease can get OIs.

One OI in people with HIV is pneumocystis pneumonia (PCP), which affects the lungs. People who have a CD4 cell count of less than 200 cells/mm³ may develop PCP.

TMP/SMX is the first choice to treat or prevent PCP. If your CD4 cell count is below 200 cells/mm³, ask your healthcare provider if you should be taking TMP/SMX or another drug to prevent PCP.

Another OI is toxoplasmosis (toxo), which affects the brain. People who have a CD4+ cell count of less than 100 may develop toxo. TMP/SMX is sometimes used to treat or prevent cases of toxo.

Some people are allergic to TMP/SMX. Be sure to tell your healthcare provider if you are allergic to sulfa drugs or antibiotics. People who are anemic should not use TMP/SMX. People who are pregnant or breastfeeding should avoid taking TMP/SMX if possible because it may increase the risk of birth defects. Also let your healthcare provider know if you have liver disease, kidney disease, or a shortage of the enzyme glucose-6-phosphate dehydrogenase (G6PD). 

WHAT ABOUT DRUG RESISTANCE?

Whenever you take medication, be sure to take all of the prescribed doses. Many people stop if they feel better. This is not a good idea. If the drug doesn’t kill all of the germs, they might change (mutate) so that they can survive even when you are taking medications. When this happens, the drug will stop working. This is called developing resistance to the drug.

For example, if you are taking TMP/SMX to fight PCP and you miss too many doses, the PCP in your body could develop resistance to TMP/SMX. Then you would have to take a different drug or combination of drugs to fight it.

HOW IS TMP/SMX TAKEN?

TMP/SMX is available in tablets that contain 80 milligrams (mg) of trimethoprim and 400 mg of sulfamethoxazole. There is also a double strength tablet with 160 mg of trimethoprim and 800 mg of sulfamethoxazole. The dose you take depends on the type of infection you are trying to treat or prevent.

The treatment continues as long as your CD4 cell count is low enough for you to develop toxo or PCP.

TMP/SMX is generally taken with food, but the single-strength tablets can be taken with or without food. Drink plenty of water when taking TMP/SMX.

WHAT ARE THE SIDE EFFECTS?

HIV infection causes higher rates of TMP/SMX side effects. People who have taken TMP/SMX before often have more side effects.

The main side effects of TMP/SMX are nausea, vomiting, loss of appetite, and allergic skin reactions (rashes). The skin rashes can be fairly common. TMP/SMX can cause Stevens-Johnson syndrome, a very serious skin rash.

TMP/SMX can also cause neutropenia, a low level of neutrophils. These are white blood cells (WBCs) that fight bacterial infections. HIV infection can also cause neutropenia.

Some healthcare providers use a desensitization procedure with people who get an allergic reaction. Starting with a very low dose of TMP/SMX that does not cause an allergic reaction, they gradually increase the dose to the full amount. Vitamin C may help in cases of allergic reactions to Bactrim. Another option is to use the drug diaminodiphenyl sulfone (Dapsone).

TMP/SMX can also make you sensitive to sunlight. If this occurs, use sun block on your skin and/or wear sunglasses.

Tell your healthcare provider if your skin gets pale or yellowish, or you get a sore throat, fever, or rash, even after a few weeks of taking TMP/SMX. These might indicate a serious drug reaction.

HOW DOES TMP/SMX REACT WITH OTHER DRUGS?

TMP/SMX is mostly processed by the kidneys. It does not interact very much with drugs that use the liver, including most antiretroviral medications (ARVs) used to treat HIV. However, TMP/SMX interacts with several other types of drugs, including some blood thinners, pills to lower blood sugar, seizure medications, and water pills. Be sure your healthcare provider knows about all the medications you are taking.

THE BOTTOM LINE

TMP/SMX is used to treat PCP and toxoplasmosis, opportunistic infections in people with HIV. It can prevent new infections or treat active infections. If your CD4 cell count is below 200 cells/mm³, talk to your healthcare provider about taking drugs to prevent PCP.

MORE INFORMATION

MedlinePlus: Co-trimoxazole

Drugs.com: sulfamethoxazole and trimethoprim

Reviewed March 2021

Print PDF

State Budgetary Institution “Regional Center for the Prevention and Control of AIDS and Infectious Diseases”

State Budgetary Institution “Regional Center for the Prevention and Control of AIDS and Infectious Diseases”

Antibiotics for angina in children: a review of drugs, choice, recommendations

Many parents have a fear of antibiotics, while others believe that this is the best medicine and independently prescribe them to their children for various diseases, especially when it comes to a protracted illness. With sore throat in children, antibiotics are sometimes the best way out. However, it should be remembered that they are not used for all types of this disease. Only a narrow profile doctor – an ENT or a pediatrician – should decide whether a child should take antibiotics. Incorrect prescription can harm the health of the child.

What type of angina do we treat?

Another name for angina is acute tonsillitis. This disease is an infectious-inflammatory process that occurs in the palatine tonsils of the pharyngeal ring. Another popular name for this disease is inflammation of the tonsils.

Follicular angina in a child: therapy and prevention

The article deals with such a disease as follicular angina in a child, the treatment of this…

Meanwhile, this common name hides four types of angina, which differ in local changes in the pharynx. That is why the answer to frequent questions from parents about whether it is necessary for a child to drink antibiotics with angina depends on what type of disease is diagnosed. In some types, antibiotics are not only not necessary, but can also be harmful to health.

• Catarrhal. It is characterized by an increase in the palatine arches and tonsils, as well as their redness, enlargement and swelling.
• Follicular. This type of angina is characterized by symptoms of a catarrhal form. However, reddened and swollen tonsils have, among other things, small yellowish pustules.
• Ulcerative membranous. The surface of the tonsil is covered with an easily removable very thin and delicate film, after the removal of which ulcers open.
• Lacunary. In the recesses of the tonsils (lacunae), pus begins to accumulate.

General symptoms

Despite local differences, for any type of angina, symptoms such as:

Inexpensive antibiotics: examples and instructions for the preparation

Colds can be caused not only by viruses. Quite often the fault is bad …

• swelling and redness of the temples and tonsils;
• fever;
• soreness and enlargement of submandibular lymph nodes;
• symptoms of intoxication;
• pain when swallowing.

Pathogens

Angina can be caused by various pathogens: spirochetes, fungi, viruses and bacteria. That is why antibiotics for angina in children are not always used.

Quite often, angina is the result of viral infections: enterovirus, herpetic, adenovirus. In this case, antibiotics will not bring absolutely no benefit, and treatment is carried out with antiviral drugs. Moreover, taking antibiotics in this case can cause a decrease in immunity, which will lead to a worsening of the condition.

In young children, effective antibiotics for sore throat can also be given to fight a secondary infection, even if the sore throat itself is caused by a virus.

Angina caused by fungi is also not treated with antibiotics. In this case, they often only exacerbate the situation.

Antibiotics are required for the treatment of bacterial tonsillitis in children. Usually they are prescribed by a doctor. Streptococci are a typical causative agent of this type of sore throat. However, palatine tonsils can affect both staphylococci and even pneumococci, but such cases are rare.

Most often, streptococci cause follicular tonsillitis, which most people know as “purulent”. Since the causative agent of this type of disease is bacteria, it is better to give a child with purulent tonsillitis an antibiotic. Which pathogens caused acute tonsillitis, only a doctor can figure it out, so it is so important not to self-medicate.

Angina: antibiotic therapy in adults. Consultation…

Angina is an infectious disease. The cause of this disease are …

Viral tonsillitis

If acute tonsillitis is of viral origin and is caused by enterovirus, herpetic or adenovirus infection, then antiviral drugs are prescribed instead of antibiotics. The doctor, even at the initial examination, in most cases can distinguish this type of angina by the following signs:

• There is no plaque on the tonsils, there is only bright redness and swelling of the tonsils.
• Herpangina suggests the presence of small blisters on the mucous membranes of the mouth and on the tonsils containing a clear liquid. Opening, they expose small sores.

Also, viral tonsillitis has previous or concomitant symptoms of rhinopharyngoconjunctivitis:

• dry cough;
• runny nose;
• lacrimation.

Bacterial tonsillitis begins with fever, and the list of accompanying symptoms can include intoxication and local symptoms such as plaque on the tonsils and sore throat.

Treatment

Typically, angina does not require hospitalization and is treated at home. A sick child should be provided with individual household items: dishes, towels, bed linen. Otherwise, other family members may become infected. Also, the room must be ventilated two to three times a day and wet cleaning should be carried out.

How much a child should take an antibiotic for angina is usually decided by a doctor. However, most often, if the drug is prescribed, then a full course is carried out. This is the nature of the medicine. Only after completing the full course can we talk about the work of the drug. Interrupted therapy will not give any results. You can always look at all dosages in the instructions.

Children are usually hospitalized in the first year of life, as well as if there are severe pathologies, such as kidney failure or diabetes. Hospitalization is also indicated for other complications, and in general in the case of a severe course of the disease.

The most common prescriptions of doctors

Antibiotics for angina in children (names below) are prescribed by doctors from the preparations of a number of penicillins, cephalosporins and macrolides.

Macrolides include:

• Sumamed;
• Spiramycin;
• Macrofoam;
• “Midecamycin”;
• Azithromycin;
• Zitrocin;
• Erythromycin.

They are prescribed in case of allergy to penicillin. It also happens that the pathogen is insensitive to penicillin drugs. “Sumamed” is one of the most popular, especially for children, as it tends to accumulate in tissues. This allows you to reduce the course of treatment to five days.

Antibiotics of the penicillin series for children are most often prescribed for angina. These include:

• “Amoxiclav”;
• Medoklav;
• Augmentin;
• “Ranklav”;
• “Ticarcillin”;
• “Amoxicillin”;
• Amoxiclavin and others.

In bacterial angina, this series of antibiotics is preferred. Most often, children tolerate them well, and the lack of attachment to meals only adds another point to their merits. If the bacterium is resistant to conventional penicillins, then Amoxiclav is prescribed – a combination of amoxicillin and clavulanic acid increases the effectiveness of the antibiotic. This group of drugs has a powerful bactericidal effect against pneumococci, staphylococci and streptococci. The latter have a special sensitivity to this series of drugs.

Cephalosporins – medicines of this group are also effective antibiotics for angina in children. These are drugs such as:

• “Cefalexim”;
• “Pancef”;
• Aksetin;
• Cefotaxime;
• Ceftriaxone and others.

Cephalosporins are an alternative in the treatment of angina. All drugs are highly active against many pathogens.

How to choose?

What antibiotic to give a child with angina? Doctors prescribe this or that drug after testing and identifying the pathogen. Physicians take material during the initial examination. Usually this is a throat swab, which is sent for further bacteriological examination. In addition to identifying the pathogen, such a study will help to exclude diphtheria – a very dangerous disease, which is also manifested by inflammation of the tonsils.

A bacteriological examination in a regular public clinic usually takes at least a couple of days. Therefore, doctors, relying on the symptoms of the disease, most often make an appointment immediately. After two or three days, the doctor examines the child again and notes the effectiveness or ineffectiveness of the prescribed drug. This can be judged by the general condition of the child, the condition of the tonsils and the temperature. If during this time there has been no improvement in well-being, and the child continues to have a fever, the doctor prescribes a new drug, based on the results of a bacteriological study.

Amoxicillin is one of the most convenient drugs for treating children. If you are interested in the question of which antibiotic for angina for a 3-year-old child is most suitable, then in most cases it will be Amoxicillin. In severe cases of the course of the disease, this drug is also prescribed, however, the introduction is made in the form of injections. Antibiotics for angina in children in the form of injections can be administered if normal intake is not possible.

“Amoxicillin” is practically non-toxic, and this is one of the most important aspects, and is available in various forms: suspension, capsules, and tablets. This diversity makes it easier to take an antibiotic for a sore throat for a child 10 years old and younger.

Doctors sometimes prevent long-term complications. In this case, after the main course, “Bicillin-3” or “Bicillin-5” may be prescribed. One injection is given per week or one per month, respectively.

General advice

Antibiotics are drugs that require a full course of treatment. Its duration is most often determined by the doctor. However, it will not be less than five days, with the exception of the already mentioned drug “Sumamed”, the course of which is from three to five days, at the discretion of the doctor.

Self-cessation of treatment after some improvement in the child’s condition may result in various complications in the kidneys, cardiovascular system. Sometimes this can result in the development of chronic tonsillitis. At the end of treatment, the doctor prescribes control tests of urine, blood and ECG.

Dosage and frequency of administration should be observed strictly according to the doctor’s instructions, because the appointments are made taking into account body weight and age, the severity of the disease and the presence or absence of other pathologies. It is better to take antibiotics for children with angina at the same hours, and drink plenty of water, but not juice, milk, lemonade or other drinks.

If the instructions indicate that the drug is not recommended for combination with meals, then you should take it either two hours after a meal or one hour before it. A doctor should be consulted if a child takes various vitamin preparations during treatment, even if it is ordinary ascorbic acid. It reduces the effect of some antibiotics, and other vitamins can lead to the development of an allergic reaction.

Even with the best antibiotics for angina, children should have plenty of fluids and good nutrition, including vegetables and fruits. It is better to refuse chemical vitamin preparations.

Complementary drugs

Since an allergic reaction can never be ruled out, doctors often recommend taking antihistamine (allergic) medications during a course of antibiotics for sore throats in children.

Names of preparations: “Tavegil”, “Fenistil”, “Diazolin”, “Zodak”, “Peritol”, “Cetrin”. The latter applies only to children older than two years.

All antibiotics are known to kill bacteria. However, together with the pathogenic flora, they also destroy the intestinal microflora. Especially if it is cephalosporins – broad-spectrum antibiotics. As a result of this, an imbalance of the intestinal microflora can develop – dysbacteriosis.

Doctors often prescribe concomitant probiotics for preventive purposes. These are “Acipol”, “Acilact”, “Biovestin”, “Biobacton”, “Lactobacterin”, “Bifiliz”, “Bifiform-baby”, “Lineks” and others. If these drugs are in the doctor’s prescription, they should be taken.

Other features

Additional topical antibiotics may be used as directed by a physician. They are used in the form of inhalations. For example, the drug “Bioparox” with a wide spectrum of antimicrobial action affects both bacteria and fungi. It also has an anti-inflammatory effect. It can be used by children over two years old. However, this does not replace the main course of antibiotics.

Some parents are surprised to learn that antibiotics do not have an antipyretic effect. When a child has a fever, along with the main drugs, it is worth giving antipyretics, such as Nurofen, Paracetamol and others.

As part of self-medication, many parents give their children sulfanilamide preparations, such as Sulfadimezin, Bactrim, Biseptol, and others. Now they are not used to treat children. Any appointment should be discussed with the doctor.

Also, with purulent sore throats, such popular folk remedies as steam inhalations and warming compresses cannot be used.

Diet and regimen

Presence of fever suggests bed rest. If there is an improvement in the condition, then it is allowed to get out of bed. However, outdoor games should be limited. Swimming and walking are possible only after the temperature returns to normal.

Nutrition recommendations are quite simple: the food of a child with a sore throat should be easy to digest, nutritious and fortified. The consumption of cold or too hot foods is excluded. It is best to serve food warm.

During the first days children often refuse to eat, but this is not a problem. Just give your child more nutritious drink. Suitable, for example, compotes, fruit drinks, rosehip broth, sweet tea with lemon. Then you can start giving the patient semi-liquid purees and broths, and then return to the usual diet. From the usual menu, everything that is capable of irritating the mucous membranes should be removed: spices, salinity, cold and hot, spicy foods, marinades, crackers.

Honey for sore throats

Honey is an excellent folk remedy that helps with many diseases. However, tonsillitis is an inflammatory process, therefore, no matter how softening this product may be, doctors do not advise giving it to patients before the acute inflammation in the tonsils subsides.

Natural honey, used in its pure form, can cause a sore throat and will irritate the mucous membranes. When the raids come down, honey can be added to tea or to the baby’s milk. It is also allowed to absorb a small amount of honey. In that case it will be useful. After all, it provides bactericidal and analgesic effects.

Instead of a conclusion

If the attending physician has established that the child has a sore throat, then the question of antibiotics should not arise, since the doctor himself will prescribe depending on the type of pathogen.