Septra DS Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Nausea, vomiting, diarrhea, and loss of appetite may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she 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: persistent headache, 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: skin rash/blisters, itching/swelling (especially of the face/tongue/throat), persistent sore throat or fever, new or worsening lymph node swelling, paleness, joint pain/aches, persistent cough, trouble breathing, easy bleeding/bruising, yellowing eyes or skin, persistent nausea/vomiting, 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.

If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.

Use of this medication for prolonged or repeated periods may result in oral thrush or a new yeast infection. 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.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Septra Dosage Guide – Drugs.com

Medically reviewed by Drugs.com. Last updated on April 30, 2020.

Generic name: TRIMETHOPRIM 80mg, SULFAMETHOXAZOLE 400mg
Dosage form: tablet

Contraindicated in pediatric patients less than 2 months of age.

Urinary Tract Infections and Shigellosis in Adults and Pediatric Patients and Acute Otitis Media in Pediatric Patients:

Adults: The usual adult dosage in the treatment of urinary tract infections is one SEPTRA DS (double strength) tablet, two SEPTRA tablets, or four teaspoonfuls (20 mL) SEPTRA Suspension every 12 hours for 10 to 14 days. An identical daily dosage is used for 5 days in the treatment of shigellosis.

Pediatric Patients: The recommended dose for pediatric patients with urinary tract infections or acute otitis media is 8 mg/kg trimethoprim and 40 mg/kg sulfamethoxazole per 24 hours, given in two divided doses every 12 hours for 10 days. An identical daily dosage is used for 5 days in the treatment of shigellosis. The following table is a guideline for the attainment of this dosage:

For Patients With Impaired Renal Function: When renal function is impaired, a reduced dosage should be employed using the following table:

Acute Exacerbations of Chronic Bronchitis in Adults:

The usual adult dosage in the treatment of acute exacerbations of chronic bronchitis is one SEPTRA DS (double strength) tablet, two SEPTRA tablets, or four teaspoonfuls (20 mL) SEPTRA Suspension every 12 hours for 14 days.

Travelers’ Diarrhea in Adults:

For the treatment of travelers’ diarrhea, the usual adult dosage is one SEPTRA DS (double strength) tablet, two SEPTRA tablets, or four teaspoonfuls (20 mL) of SEPTRA Suspension every 12 hours for 5 days.

Pneumocystis Carinii Pneumonia:

Treatment:

Adults and Pediatric Patients: The recommended dosage for treatment of patients with documented Pneumocystis carinii pneumonia is 15 to 20 mg/kg trimethoprim and 75 to 100 mg/kg sulfamethoxazole per 24 hours given in equally divided doses every 6 hours for 14 to 21 days. The following table is a guideline for the upper limit of this dosage:

For the lower limit dose (15 mg/kg trimethoprim and 75 mg/kg sulfamethoxazole per 24 hours) administer 75% of the dose in the above table.

Prophylaxis:

Adults: The recommended dosage for prophylaxis in adults is one SEPTRA DS (double strength) tablet daily.

Pediatric Patients: For pediatric patients, the recommended dose is 150 mg/m2/day trimethoprim with 750 mg/m2/day sulfamethoxazole given orally in equally divided doses twice a day, on 3 consecutive days per week. The total daily dose should not exceed 320 mg trimethoprim and 1,600 mg sulfamethoxazole. The following table is a guideline for the attainment of this dosage in pediatric patients:

Frequently asked questions

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Septra Drug Interactions – Drugs.com

A total of 370 drugs are known to interact with
Septra (sulfamethoxazole / trimethoprim).

• 54 major
  drug interactions
• 122 moderate
  drug interactions
• 194 minor
  drug interactions

View all medications that may interact with Septra (sulfamethoxazole / trimethoprim).

Does Septra interact with my other drugs?

Enter other medications to view a detailed report.

Most frequently checked interactions

View interaction reports for Septra (sulfamethoxazole / trimethoprim) and the medicines listed below.

Septra (sulfamethoxazole / trimethoprim) alcohol/food interactions

There is 1 alcohol/food interaction with Septra (sulfamethoxazole / trimethoprim)

Septra (sulfamethoxazole / trimethoprim) disease interactions

There are 12 disease interactions with Septra (sulfamethoxazole / trimethoprim) which include:

More about Septra (sulfamethoxazole / trimethoprim)

Related treatment guides

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Bactrim, Bactrim DS (trimethoprim/sulfamethoxazole) dosing, indications, interactions, adverse effects, and more

Contraindications

Known hypersensitivity

Age

CrCl

Documented megaloblastic or folate deficiency anemia

Significan hepatic impairment

Contraindicated in pregnant patients at term and in nursing mothers, because sulfonamides, which pass the placenta and are excreted in the milk, may cause kernicterus

History of drug-induced immune thrombocytopenia with use of trimethoprim and/or sulfonamides

Concomitant administration with dofetilide

Cautions

Not for use in areas with resistance rates >10%

Treatment with recommended doses may cause hyperkalemia when trimethoprim is administered to patients with underlying disorders of potassium metabolism, with renal insufficiency, or if drugs known to induce hyperkalemia are given concomitantly; close monitoring of serum potassium recommended

Severe and symptomatic hyponatremia can occur in patients receiving sulfamethoxazole/ trimethoprim, particularly for treatment of P. jirovecii pneumonia; evaluation for hyponatremia and appropriate correction is necessary in symptomatic patients to prevent life-threatening complications; if patient treated for Pneumocystis jirovecii develops skin rash, fever, leukopenia, or any other sign of adverse reaction, therapy or re-challenge should be re-evaluated

Circulatory shock with fever, severe hypotension, and confusion requiring intravenous fluid resuscitation and vasopressors has occurred within minutes to hours of re-challenge with trimethoprim-sulfamethoxazole in patients with history of recent (days to weeks) exposure to sulfamethoxazole-trimethoprim

Fatalities associated with the administration of sulfonamides, although rare, have occurred due to severe reactions, including severe cutaneous adverse reactions (SCARs), including Stevens-Johnson Syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP) and acute febrile neutrophilic dermatosis (AFND), fulminant hepatic necrosis, agranulocytosis, aplastic anemia and other blood dyscrasias; clinical signs, such as rash, sore throat, fever, arthralgia, pallor, purpura or jaundice may be early indications of serious reactions

Caution when used in elderly individuals; risk of bone marrow suppression

PCP prophylaxis with AIDS: Rash, fever, leukopenia, and elevated transaminase values reported; hyperkalemia and hyponatremia also appear to be increased

Severe cases (including fatalities) of immune-mediated thrombocytopenia reported; monitor patients for hematologic toxicity

Sulfonamides should not be used to treat group A beta-hemolytic streptococcal infections; they will not eradicate streptococcus or prevent rheumatic fever

Clostridium difficile-associated diarrhea reported

Coadministration with leucovorin for the treatment of HIV-positive patients with PCP resulted in treatment failure and excess mortality in a randomized, placebo-controlled trial; avoid coadministration

Development of drug-resistant bacteria may occur when prescribed in absence of strongly suspected bacterial infection or prophylactic indication

Prolonged use may result in fungal or bacterial superinfection

Caution with impaired renal or hepatic function, patients with possible folate deficiency (eg, the elderly, chronic alcoholics, patients receiving anticonvulsant therapy, patients with malabsorption syndrome, and patients in malnutrition states), and patients with severe allergies or bronchial asthma

Hemolysis may occur if administered to patients with G6PD deficiency

Hypoglycemia (rare) reported in nondiabetic patients; patients with renal dysfunction, liver disease, or malnutrition or those receiving high doses at particular risk

Trimethoprim may impair phenylalanine metabolism

Caution with porphyria or thyroid dysfunction; sulfonamides can precipitate porphyria crisis and hypothyroidism; avoid use in patients with porphyria or thyroid dysfunction

Complete blood counts should be done frequently in patients receiving therapy; discontinue therapy if a significant reduction in count of any formed blood element is noted’ perform urinalyses with careful microscopic examination and renal function tests during therapy, particularly for those patients with impaired renal function

When administered at high doses as for the treatment of P. jirovecii pneumonia, monitor for total daily intake of propylene glycol from all sources and for acid-base disturbances; discontinue therapy if propylene glycol toxicity suspected

Treatment failure and excess mortality were observed when trimethoprim-sulfamethoxazole was used concomitantly with leucovorin for treatment of HIV positive patients with Pneumocystis jirovecii pneumonia; co-administration of trimethoprim-sulfamethoxazole and leucovorin during treatment of Pneumocystis jirovecii pneumonia should be avoided

During treatment, adequate fluid intake and urinary output should be ensured to prevent crystalluria; patients who are “slow acetylators” may be more prone to idiosyncratic reactions to sulfonamides

Trimethoprim/Sulfamethoxazole | PeaceHealth

Drug Information

The antibiotic combination of trimethoprim and sulfamethoxazole (TMP/SMX) is used to treat a wide variety of bacterial infections and some infections due to parasites. Bactrim, Cotrim, and Septra are brand names for products containing identical amounts of TMP/SMX. Bactrim DS and Septra DS contain twice as much TMP and SMX as Bactrim and Septra.

Common brand names:

Bactrim DS, Cotrim DS, Septra DS, SMZ-TMP DS

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions:
Beneficial
Adverse
Check

Replenish Depleted Nutrients

• Folic Acid

  The use of multivitamin supplements containing folic acid diminishes the occurrence of birth defects associated with trimethoprim. According to one study, pregnant women who took folic acid–containing multivitamin supplements in addition to their prescription drugs had fewer babies with heart defects and deformities of the upper lip and mouth.

  The combination drug trimethoprim/sulfamethoxazole (TMP/SMX) has been rarely associated with folic acid-deficiency anemia. This action may be due to trimethoprim-induced folic acid depletion. Trimethoprim and TMP/SMX should be used with caution in patients with folic acid deficiency, for which blood tests are available. Folic acid replacement does not interfere with the antibacterial activity of trimethoprim or TMP/SMX.

• Potassium

  Tetracycline can interfere with the activity of folic acid, potassium, and vitamin B2, vitamin B6, vitamin B12, vitamin C, and vitamin K. This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation. Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study. The importance of this interaction is unknown.

  Taking large amounts of niacinamide, a form of vitamin B3, can suppress inflammation in the body. According to numerous preliminary reports, niacinamide, given in combination with tetracycline or minocycline, may be effective against bullous pemphigoid, a benign, autoimmune blistering disease of the skin. Preliminary evidence also suggests a similar beneficial interaction may exist between tetracycline and niacinamide in the treatment of dermatitis herpetiformis.

• Vitamin B12

  Neomycin can decrease absorption or increase elimination of many nutrients, including calcium, carbohydrates, beta-carotene, fats, folic acid, iron, magnesium, potassium, sodium, and vitamin A, vitamin B12, vitamin D, and vitamin K. Surgery preparation with oral neomycin is unlikely to lead to deficiencies. It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.

• Vitamin B2

  Tetracycline can interfere with the activity of folic acid, potassium, and vitamin B2, vitamin B6, vitamin B12, vitamin C, and vitamin K. This is generally not a problem when taking tetracycline for two weeks or less. People taking tetracycline for longer than two weeks should ask their doctor about vitamin and mineral supplementation. Taking 500 mg vitamin C simultaneously with tetracycline was shown to increase blood levels of tetracycline in one study. The importance of this interaction is unknown.

• Vitamin K

  Several cases of excessive bleeding have been reported in people who take antibiotics. This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal. Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

• Calcium

  Sulfonamides, including sulfamethoxazole, can decrease absorption of calcium, magnesium, and vitamin B12. This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

  Note:Since sulfamethoxazole is often prescribed in combination with trimethoprim (for example, in Bactrim or Septra), it may be easy to associate this interaction with trimethoprim. However, this interaction is not known to occur with trimethoprim alone.

  The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

• Magnesium

  Sulfonamides, including sulfamethoxazole, can decrease absorption of calcium, magnesium, and vitamin B12. This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

  The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

• Vitamin B6

  Sulfonamides, including sulfamethoxazole, can interfere with the activity of folic acid, vitamin B6, and vitamin K. This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

  Note:Since sulfamethoxazole is often prescribed in combination with trimethoprim (for example, in Bactrim or Septra), it may be easy to associate this interaction with trimethoprim. However, this interaction is not known to occur with trimethoprim alone.

  The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

• Probiotics

  A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.

  The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii or Saccharomyces cerevisiae (baker’s or brewer’s yeast)—helps prevent recurrence of this infection.

  Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.

• Vitamin C

  Tooth discoloration is a side effect of minocycline observed primarily in young children, but it may occur in adults as well. Vitamin C supplementation may prevent staining in adults taking minocycline.

• Brewer’s Yeast

  A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.

  The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii or Saccharomyces cerevisiae (baker’s or brewer’s yeast)—helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection. Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

  Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.

  The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Support Medicine

• Bromelain

  When taken with amoxicillin, bromelain was shown to increase absorption of amoxicillin in humans. When 80 mg of bromelain was taken together with amoxicillin and tetracycline, blood levels of both drugs increased, though how bromelain acts on drug metabolism remains unknown. An older report found bromelain also increased the actions of other antibiotics, including penicillin, chloramphenicol, and erythromycin, in treating a variety of infections. In that trial, 22 out of 23 people who had previously not responded to these antibiotics did so after adding bromelain taken four times per day.

  Doctors will sometimes prescribe enough bromelain to equal 2,400 gelatin dissolving units (listed as GDU on labels) per day. This amount would equal approximately 3,600 MCU (milk clotting units), another common measure of bromelain activity.

• Probiotics

  In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection. Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

Reduces Effectiveness

• Khat

  Khat (Catha edulis) is an herb found in East Africa and Yemen that has recently been imported into the United States. Studies have shown that chewing khat significantly reduces the absorption of ampicillin, which might reduce the effectiveness of the antibiotic. Therefore, people taking ampicillin should avoid herbal products that contain khat.

• Magnesium

  Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.

• Zinc

  Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.

Potential Negative Interaction

• Potassium

  The combination drug trimethoprim/sulfamethoxazole (TMP/SMX) has been reported to elevate blood potassium and other constituents of blood (creatine and BUN). In particular, people with impaired kidney function should be closely monitored by their prescribing doctor for these changes. People taking trimethoprim or TMP/SMX should talk with the prescribing doctor before taking any potassium supplements or potassium-containing products, such as No Salt, Salt Substitute, Lite Salt, and even high-potassium foods (primarily fruit).

• PABA

  PABA (para-aminobenzoic acid) may interfere with the action of sulfamethoxazole. It should not be taken together with trimethoprim/sulfamethoxazole.

  The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

• Barberry

  Berberine is a chemical extracted from goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), and Oregon grape (Berberis aquifolium), which has antibacterial activity. However, one double-blind study found that 100 mg berberine given with tetracycline (a drug closely related to doxycycline) reduced the efficacy of tetracycline in people with cholera. In that trial, berberine may have decreased tetracycline absorption. Another double-blind trial found that berberine neither improved nor interfered with tetracycline effectiveness in cholera patients. Therefore, it remains unclear whether a significant interaction between berberine-containing herbs and doxycycline and related drugs exists.

• Vitamin K

  Several cases of excessive bleeding have been reported in people who take antibiotics. This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal. Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

  The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

Sulfamethoxazole; Trimethoprim, SMX-TMP tablets

What is this medicine?

SULFAMETHOXAZOLE; TRIMETHOPRIM or SMX-TMP (suhl fuh meth OK suh zohl; trye METH oh prim) is a combination of a sulfonamide antibiotic and a second antibiotic, trimethoprim. It is used to treat or prevent certain kinds of bacterial infections. It will not work for colds, flu, or other viral infections.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Bacter-Aid DS, Bactrim, Bactrim DS, Septra, Septra DS

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• anemia
• asthma
• being treated with anticonvulsants
• if you frequently drink alcohol containing drinks
• kidney disease
• liver disease
• low level of folic acid or glucose-6-phosphate dehydrogenase
• poor nutrition or malabsorption
• porphyria
• severe allergies
• thyroid disorder
• an unusual or allergic reaction to sulfamethoxazole, trimethoprim, sulfa drugs, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Take this medicine by mouth with a full glass of water. Follow the directions on the prescription label. Take your medicine at regular intervals. Do not take it more often than directed. Do not skip doses or stop your medicine early.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed. This medicine has been used in children as young as 2 months of age.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:

• aminobenzoate potassium
• dofetilide
• metronidazole

This medicine may also interact with the following medications:

• ACE inhibitors like benazepril, enalapril, lisinopril, and ramipril
• birth control pills
• cyclosporine
• digoxin
• diuretics
• indomethacin
• medicines for diabetes
• methenamine
• methotrexate
• phenytoin
• potassium supplements
• pyrimethamine
• sulfinpyrazone
• tricyclic antidepressants
• warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Tell your doctor or health care professional if your symptoms do not improve. Drink several glasses of water a day to reduce the risk of kidney problems.

Do not treat diarrhea with over the counter products. Contact your doctor if you have diarrhea that lasts more than 2 days or if it is severe and watery.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use a sunscreen. Do not use sun lamps or tanning beds/booths.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash or hives, swelling of the face, lips, or tongue
• breathing problems
• fever or chills, sore throat
• irregular heartbeat, chest pain
• joint or muscle pain
• pain or difficulty passing urine
• red pinpoint spots on skin
• redness, blistering, peeling or loosening of the skin, including inside the mouth
• unusual bleeding or bruising
• unusually weak or tired
• yellowing of the eyes or skin

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

• diarrhea
• dizziness
• headache
• loss of appetite
• nausea, vomiting
• nervousness

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.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 20 to 25 degrees C (68 to 77 degrees F). Protect from light. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Diagnosis and Management of Uncomplicated Urinary Tract Infections

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Urinary tract infection: traditional pharmacologic therapies. Dis Mon.
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Fenner DE.
Urinary tract infections. Clin Obstet Gynecol.
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Stamm WE.
Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am.
1997;11:551–81.

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Infections of the urinary tract in women: a prospective, longitudinal study of 235 women observed for 1–19 years. Medicine (Baltimore).
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2002;24:2088–104.

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Thornsberry C,
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Susceptibility of antimicrobial-resistant urinaryEscherichia coli isolates to fluoroquinolones and nitrofurantoin. Clin Infect Dis.
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Multidrug-resistant urinary tract isolates ofEscherichia coli: prevalence and patient demographics in the United States in 2000. Antimicrob Agents Chemother.
2001;45:1402–6.

16. Seifert R, Weinstein DM, Li-McLeod J. National prevalence of Escherichia coli resistance to trimethoprim-sulfamethoxazole: managed care implications in the treatment of urinary tract infections. J Manag Care Pharm 2001;7:132. Accessed online May 4, 2005, at:http://www.amcp.org/data/jmcp/jmcp_2001_7_2.pdf.

17. Naber KG.
Treatment options for acute uncomplicated cystitis in adults. J Antimicrob Chemother.
2000;46(suppl 1):S23–7.

18. Iravani A,
Tice AD,
McCarty J,
Sikes DH,
Nolen T,
Gallis HA,

et al.,
for the Urinary Tract Infection Study Group.
Short-course ciprofloxacin treatment of acute uncomplicated urinary tract infection in women. The minimum effective dose [published correction appears in Arch Intern Med 1995;155:871]. Arch Intern Med.
1995;155:485–94.

19. Richard GA,
Mathew CP,
Kirstein JM,
Orchard D,
Yang JY.
Single-dose fluoroquinolone therapy of acute uncomplicated urinary tract infection in women: results from a randomized, double-blind, multicenter trial comparing single-dose to 3-day fluoroquinolone regimens. Urology.
2002;59:334–9.

20. Stein GE.
Comparison of single-dose fosfomycin and a 7-day course of nitrofurantoin in female patients with uncomplicated urinary tract infection. Clin Ther.
1999;21:1864–72.

21. Fosfomycin for urinary tract infections.
Med Lett Drugs Ther.
1997;39:66–8.

22. Jepson RG,
Mihaljevic L,
Craig J.
Cranberries for treating urinary tract infections. Cochrane Database Syst Rev.
2000;(2):CD001322.

23. Gomolin IH,
Siami PF,
Reuning-Scherer J,
Haverstock DC,
Heyd A,
for the Oral Suspension Study Group..
Efficacy and safety of ciprofloxacin oral suspension versus trimethoprim-sulfamethoxazole oral suspension for treatment of older women with acute urinary tract infection. J Am Geriatr Soc.
2001;49:1606–13.

24. Warren JW,
Abrutyn E,
Hebel JR,
Johnson JR,
Schaeffer AJ,
Stamm WE.
Infectious Diseases Society of America (IDSA). Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Clin Infect Dis.
1999;29:745–58.

25. Lutters M,
Vogt N.
Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database Syst Rev.
2002;(3):CD001535.

Septra Tablet / Septra Tablet in English – Item

apache-spark – Changing the shape of the spark RDD

I have a Spark RDD like this:

  rdd = sc.parallelize ([('X01', 'Y01'),
                   ('X01', 'Y02'),
                   ('X01', 'Y03'),
                   ('X02', 'Y01'),
                   ('X02', 'Y06')])
  

I would like to convert them to the following format:

  [('X01', ('Y01', 'Y02', 'Y03')),
 ('X02', ('Y01', 'Y06'))]
  

Can someone help me how to achieve this using PySpark?

0

Dileep Kumar Patchigolla

7 Feb 2017 at 11:41

3 answers

Best answer

Simple Operation groupByKey is what you need.

  rdd.groupByKey (). MapValues ​​(lambda x: tuple (x.data)). Collect ()
  

Result: [('X02', ('Y01', 'Y06')), ('X01', ('Y01', 'Y02', 'Y03'))] Code>

one

septra
7 Feb 2017 at 09:29

As Septra said, the groupByKey method is what you need.Also, if you want to apply an operation to all values ​​for a specific key, then you can do the same with the mapValues ​​() method. This method will use one method (the logic you want to apply to the grouped values) and apply to all the grouped values ​​for each key. If you want both operations to be done in one go, you can use the “reduByKey” method. You can use “reduByKey () = groupByKey () + mapValues ​​()”

0

Kapil kumar
22 March 2017 at 17:07

Convert RDD to PairRDD using mapToPair (// with key as first column and the value will be rest of the record) , and execute groupByKey on the resulting RDD.

one

Aviral kumar
7 Feb 2017 at 11:37

90,000 Clinical Study Obesity: Sulfamethoxazole / Trimethoprim – Clinical Trials Registry

Inclusion Criteria:

– Male and female subjects over 18 years of age of any racial or ethnic origin.

– We are recruiting 12 people of normal weight or underweight (BMI 40 kg / m2) for this study. This index is calculated based on the height and weight of the volunteer (Formula: weight (lb) / [height (inch)] 2 x 703). Half of each group will be male; the other half will be female.

Exclusion Criterion:

– Pregnant, breastfeeding or unwillingness to use a reliable method of contraception during pregnancy. to study. The effect of sulfamethoxazole and trimethoprim on pregnancy is unknown.In addition, the metabolic changes accompanying pregnancy may alter the concentration-time profile of sulfamethoxazole and trimethoprim, so that pregnancy and postpartum status would be a mixed variable.

– Abnormal liver function tests: the level of transaminases is 10 times the upper limit of normal, alkaline phosphatase is> 5 times higher than the upper limit of normal, total bilirubin is> 5 times the upper limit of normal.

– History of allergy to sulfones, sulfonamides or trimethoprim.

– Sulfones, sulfonamides or trimethoprim are contraindicated for any reason.

– Volunteers unwilling to follow research procedures.

– Current suspected or documented ear infection, urinary tract infection, bronchitis, traveler’s diarrhea, Pneumocystis carinii pneumonia, or any other bacterial infection.

– Volunteers with colon resection, gastric bypass, knee bandage or any other condition inhibits absorption of the drug in the stomach.

– Current or previous participation within 28 days of enrollment in another study study that involves the use of drugs, contrast, or any other compound that may alter a blood test and / or a biochemical blood test (liver function, kidney function, or electrolyte balance), unless otherwise specified.

– Donation of 450 ml (one unit) of blood or more within 8 weeks (56 days) prior to the enrollment study, unless PI is indicated.

– Current contraindications for sulfamethoxazole / trimethoprim medications: Bepridil, Cisapride, Dofetilide, Levometadil, Mesoridazine, Pimozide, Terfenadine, and thioridazine.Other medicines will be tested by researchers to ensure the safety of study participants and to maintain the quality of the study.

Treatment and prevention of chronic sinusitis

The criteria for the effectiveness of the treatment of chronic sinusitis are:

• Reduction of sinus inflammation
• Improvement of patency of nasal passages
• Reduction in the number of exacerbations of sinusitis
• Elimination of the main cause of the disease

Drug treatment .Your doctor may recommend treatment to ease your sinusitis symptoms. For example, drugs such as:

• Saline Nasal Spray . Which needs to be injected into the nose several times a day to flush the nasal passages.
• Corticosteroids for the nose. These nasal sprays can prevent or treat inflammation.
• Oral or injectable corticosteroids. These drugs are intended to reduce inflammation caused by severe sinusitis, especially in the presence of nasal polyps.Examples of drugs are pridnisolone and methylprednisolone. Long-term use of oral corticosteroids can cause serious side effects, so they are usually taken only to relieve symptoms of severe asthma.
• Decongestants. These medicines are available without a prescription, including nasal drops and sprays. They can be used for only a few days, otherwise they can increase the swelling of the mucous membrane or lead to a condition known as the “addict’s nose”, when everything is required to a larger dose to reduce nasal congestion.
• Over-the-counter pain relievers. For example, aspirin, acetaminophen (Tylenol et al.) And ibuprofen (Edvil, Motrin et al.). Aspirin should not be given to children.
• Antibiotics. Antibiotics are sometimes needed to treat chronic sinusitis caused by a bacterial infection. However, antibiotics cannot cure chronic nonbacterial sinusitis. To treat an exacerbation of chronic sinusitis caused by a bacterial infection, the doctor may prescribe antibiotics such as: amoxicillin (Amoxil, Trimox, etc.), doxycycline (Dorix, Monodox, etc.), macrolides (Klacid, Sumamed, etc.) and the combined drug trimethoprim-sulfamethoxazole (Bactrim, Septra, etc.). If the nature of the infection is uncertain or the sinusitis recurs, your doctor may prescribe a different antibiotic. If your doctor has prescribed antibiotics for you, you need to complete the full course of treatment. This means that you need to take them for 10 to 14 days, even if the condition has already improved. If antibiotics are stopped prematurely, symptoms may return.
• Immunotherapy. If sinusitis is accompanied by allergies, allergen immunotherapy can be tried, which will reduce the body’s response to allergens and help improve the condition.

Puncture of the maxillary sinus or treatment without puncture using the YAMIK catheter. The principle of treatment with the YAMIK sinus catheter is to periodically create either negative or positive pressure in the nasal passage. The alternation of negative and positive pressure leads to pumping out and evacuation of purulent accumulations from the paranasal sinuses.

Surgical treatment

In cases where conservative treatment does not help, endoscopic surgery is performed. To perform this procedure, the doctor uses an endoscope (a thin tube with a video camera and light) to examine the nasal passages. Further, depending on the nature of the obstacle, the doctor can remove tissue with various tools or eliminate polyps that block the passage of contents from the paranasal sinuses.

In carrying out surgical treatment of the nasal cavity and sinuses, we adhere to the concept of Walter Messerklinger, which in recent years has grown into a whole surgical direction (functional endonasal sinus surgery, FESS). Functional endonasal (through the nostril) microsurgery is based on the principle of sparing surgical intervention in special areas. With this approach, with a shaver (micro razor), only the affected or abnormally located tissues are removed with maximum preservation of the “healthy” mucous membrane.The goal of surgical treatment, with FESS surgery, is to restore the natural ventilation and drainage tracts (anastomosis).

Prevention of chronic sinusitis

Avoid upper respiratory tract infections. Minimize contact with people with colds. Wash your hands often with soap and water, especially before eating.

If available, monitor, manage your allergies.

Avoid smoking rooms and places with polluted air.Tobacco smoke and other pollutants can cause irritation and inflammation in the nasal passages and lungs.

Use humidifiers. If the air in your home is dry, for example, you have air heating, then using a humidifier will help prevent sinusitis. Keep the appliance clean and free of mold.

For more information on the treatment and prevention of chronic sinusitis, contact the otolaryngologists of the Zdorovye 365 clinic.Yekaterinburg.

Haskell Parsec – parsing two lists of things

I’m using Advent of Code part 16 as an excuse to learn how to use Parsec, but I’m stumbling over how to handle this particular case.

The input data is in the following format:

  Before: [3, 2, 3, 0]
2 3 1 1
After: [3, 2, 3, 0]

Before: [1, 0, 2, 1]
7 0 1 1
After: [1, 1, 2, 1]

...

Before: [0, 0, 2, 1]
6 2 3 1
After: [0, 6, 2, 1]



5 0 2 3
5 1 3 1
.....
5 3 2 2
  

In other words, first a series of groups of three lines that are parsed into a structure separated by blank lines, then three blank lines, then a series of four-digit lines.

I have working Parsers for each of the structures – Sample and MaskedOperation , with parsers sample and maskedOp respectively ¹ – but I can’t figure out how to put them together to parse them into ([Sample], [MaskedOperation]) .

I tried the following:

  parseInput :: GenParser Char st ([Sample], [MaskedOperation])
parseInput = do
  samples <- sample `sepBy` (count 2 newline) <* count 3 newline
  operations <- maskedOp `sepBy` newline
  return (samples, operations)
  

but it fails when it reaches three new lines, waiting for another pattern:

  (line 3221, column 1):
unexpected "\ n"
expecting "Before:"
  

How do I tell parsec that I want to take as much as it can, then use a delimiter (extra newlines), and then start reading other things?

¹ Read Code Appearance Issue for Context; names are not important.

haskell

parsec

Share

Source

Tomas Aschan

January 23, 2019 at 08:49 PM

2 answers

• Writing a parser from scratch in Haskell

  Is there any good tutorial for writing a parser for a given grammar in Haskell from scratch? I found: parsing expressions and operators (HaskellWiki) Parsing a simple imperative language (HaskellWiki) Using parsec (Real World Haskell) but they all use a library...

• combinators parsec and text / ByteString

  The Haskell Parser / Parsec Combinator supports input streams from Data.ByteString and Data.Text. Are there any plans to add additional support for these types in future releases? Combinators (many, sepby, string ...) seem to be built around lists, and the reason human is using ...

3

I'm afraid you can't use the sepBy here.

Let's simplify it to parse 'a' as patterns and 'b' as new lines. You are going to parse strings like

a b b a b b b c b c b c b

So what does the parser think when traversing such a line? Let's get through this:

Parse a or empty sequence

[a] b b a b b b c b c b c b

O, a . The sequence is not empty, so from now on I will be parsing many "bb" >> "a" .

a [b b a] b b b c b c b c b

Success! Let's take some more or finish

a b b a [b b] b c b c b c b

Ok, I found another bb , so the sequence continues. Parsing a

a b b a b b [b] c b c b c b

wat

The problem is that the parser will not rollback unless explicitly asked to do so by .To enable the parser to rollback, you must mark it with the try combinator, otherwise it cannot "unconsume" consume the input.

At the moment I see no better way than to rewrite the sepBy combinator so that it knows that after parsing each separator, it might have to put it back into the buffer if parsing separator >> target fails:

  sepTry a sep = sepTry1 a sep <|> pure []
sepTry1 a sep = liftA2 (:) a (many (try $ sep *> a))
  

Note that parsing a must be included in the try section - this is where the failure actually occurs.

To visualize the difference, let's look at the same scenario, but with sepTry instead:

...

a [b b a] b b b c b c b c b

Success! Let's try get another one if possible

a b b a! [B b] b c b c b c b

Ok, I found another bb , so the sequence continues.Parsing a

a b b a! B b [b] c b c b c b

Not what I expected. Reverse the error and move the cursor back to the exclamation mark.

a b b a! [] B b b c b c b c b

Parse failed bba , parse sequence complete. Parsing bbb

a b b a [b b b] c b c b c b

Success!

In your case, after every Sample this parser will try to read 2 new lines with Sample after them, or in case of failure 3 new lines and continue to MaskedOperation with

Share

radrow

January 23, 2019 at 10:56 PM

1

What I did was do the tokenization step first and then use Parser String ([Sample], [Instruction]) instead of Parser Char ([Sample], [Instruction]) .Having a bulleted list made it much easier to ignore whitespace and other inappropriate punctuation marks.

  solve = parse. tokenize
  where tokenize = concatMap words. lines. filter (not. (`elem`",: [] "))
        parse = (,) <$> many sample <*> many instr
        sample = - ...
        instr = - ...
  

There is no need to go back because samples and instructions are only distinguishable by their first marker.

Share

amalloy

24 January 2019 at 07:30

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90,000 Allergies to sulfites and sulfonamides: what is common?

Allergies to sulfonamides, also known as sulfa drugs, are common in our time.

Sulfonamide preparations became the first successful treatment for bacterial infections in the 1930s. They are still used in combination with antibiotics and other medications such as diuretics and anticonvulsants. People with HIV are at particular risk for sulfonamide sensitivity.

Because their names are similar, people often confuse sulfonamides with sulfites. Sulfites are found naturally in most wines. They are also used as a preservative in other foods.Sulfites and sulfa drugs are not chemically related, but both can cause allergic reactions in humans.

Allergy to sulfonamides

Symptoms of an allergic reaction to this drug include:

• urticaria
• swelling of the face, lips, tongue and throat
• drop in blood pressure
• anaphylactic shock (severe, life-threatening reaction requiring immediate medical attention)

In rare cases, symptoms similar to serum sickness may occur approximately 10 days after starting treatment with sulfonamide.Symptoms include:

• high temperature
• skin rashes
• urticaria
• joint pain
• enlargement of lymph nodes

You should contact your doctor immediately if you have these symptoms while taking sulfonamides.

Medicines to avoid

Avoid the following medicines if you are allergic or sensitive to sulfonamides:

• Combined antibiotics such as trimethoprim-sulfamethoxazole (Septra, Bactrim) and erythromycin-sulfisoxazole (Erisol, Pediazol)
• sulfasalazine (azulfidine), which is used for Crohn's disease, ulcerative colitis and rheumatoid arthritis
• dapsone (Aczone), which is used to treat leprosy, dermatitis and certain types of pneumonia

Some preparations may also contain sulfonamides.These include:

• Certain drugs for diabetes, including glyburide (clay, diabetes) and glimepiride (amaryl)
• migraine medicine sumatriptan (Imitrex, Sumavel and Dosepro)
• some diuretics, including hydrochlorothiazide (microside) and furosemide (lasix)

If you are allergic to sulfonamides, consult your allergist before using other medicines, in particular those listed above.

Allergy to sulfites

Symptoms of an allergic reaction to sulfites include:

• headache
• rash
• urticaria
• swelling of the tongue and lips
• shortness of breath or breathing problems
• asthma attack (in people with asthma)
• anaphylaxis

If you experience more severe sulfite allergy symptoms, see your doctor. Anaphylaxis is a medical emergency.

According to the Cleveland Clinic, people with asthma are 1 in 20 to 1 in 100 people with asthma.

Sulfites are common in processed foods, condiments, and alcoholic beverages such as red and white wine. Sulfites occur naturally in wine during fermentation, and many winemakers add them to aid in the process.

For the past two decades, the Food and Drug Administration (FDA) has required winemakers to display a “contains sulfites” warning if levels exceed a certain threshold.Many companies voluntarily add labels to their products.

If you have a sensitivity, you should avoid foods with the following chemicals on the label:

• sulfur dioxide
• potassium bisulfate
• potassium metabisulfite
• sodium bisulfite
• sodium metabisulfite
• sodium sulfite

Consult a doctor

Talk with your doctor to determine the best course of action if you suspect you are allergic to sulfate or sulfite.You may need to see a specialist or undergo additional testing. Be sure to talk to your doctor about which medications and foods to avoid, especially if you have asthma.

Trimethoprim / sulfamethoxazole - Trimethoprim / sulfamethoxazole

Antibiotic

Trimethoprim / Sulfamethoxazole ( TMP / SMX ), also known as co-trimoxazole among other names, is an antibiotic used to treat various bacterial infections.It consists of one part trimethoprim and five parts sulfamethoxazole. It is used for urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) skin infections, travelers' diarrhea, respiratory tract infections, and cholera, among others. It can be used both to treat and prevent Pneumocystis pneumonia and toxoplasmosis in people with HIV / AIDS and other causes of immunosuppression. It can be administered orally or intravenously.

Common side effects include nausea, vomiting, rash, and diarrhea. Occasionally, severe allergic reactions and Clostridium difficile infection can occur. Its use during pregnancy is not recommended. It appears to be safe to use while breastfeeding as long as the baby is healthy. TMP / SMX usually kills bacteria. It works by blocking the production and use of folate by microorganisms.

The

TMP / SMX was first sold in 1974. It is listed on the World Health Organization's List of Essential Medicines. It is available as a generic drug. In 2018, it was 91st on the list of most commonly prescribed drugs in the United States, with over 8 million prescriptions.

Medical use

Co-trimoxazole has been argued to be more effective than either of its components alone in treating bacterial infections, although this has since been disputed.Because it has a higher incidence of side effects, including allergic reactions, its use has been limited in many countries by very specific circumstances where its increased effectiveness has been demonstrated. It can be effective in a variety of upper and lower respiratory tract infections, kidney and urinary tract infections, gastrointestinal infections, skin and wound infections, sepsis and other infections caused by susceptible organisms.Co-trimoxazole reduces the risk of retinochoroiditis recurrence. The global problem of the development of antimicrobial resistance has recently led to renewed interest in the use of co-trimoxazole.

Susceptibility

Organisms against which cotrimoxazole may be effective include:

The only known insensitive organisms are Pseudomonas aeruginosa , mycoplasmas and Francisella tularensis (the causative agent of tularemia).

Pregnancy and breastfeeding

Its use during pregnancy is contraindicated, although it has been classified in Australian pregnancy category C and American pregnancy category D. Its use during the first trimester (during organogenesis) and 12 weeks before pregnancy has been associated with an increased risk of congenital malformations. especially malformations associated with maternal folate deficiency (most likely due to the mechanism of action of co-trimoxazole), such as neural tube defects such as spina bifida, cardiovascular malformations (eg, Ebstein's anomaly), urinary defects pathways, clefts and clubfoot in epidemiological studies.Its use during pregnancy also increases the risk of premature birth (odds ratio: 1.51) and low birth weight (odds ratio: 1.67). Animal studies have yielded equally discouraging results.

It is safe to use while breastfeeding as long as the baby is healthy.

Babies

Its use under 2 months of age is not recommended due to the risk of side effects.

Side effects

Contraindications

Contraindications include the following:

• Known hypersensitivity to trimethoprim, sulfonamides, or any of the other ingredients in the formulations.
• Pregnancy - especially before childbirth
• Severe liver failure, severe damage to the liver parenchyma or jaundice.
• Serious hematological disorders and porphyria (due to the sulfanilamide component of the drug).
• Severe chronic kidney disease (CrCl <15 ml / min), in which it is impossible to repeat plasma concentration measurements
• Co-trimoxazole should not be given to infants for the first 6 weeks, except for treatment / prevention Pneumocystis jirovecii ( P.carinii ) in children four weeks of age and older.

Interactions

Its use is not recommended for patients who are simultaneously undergoing treatment:

• ACE inhibitors such as captopril, enalapril, lisinopril, perindopril and ramipril, due to the potential for additional hyperkalemic effects
• Prilocaine - additional risk of methemoglobinemia
• Antiarrhythmics such as amiodarone (increased risk of ventricular arrhythmias) and dofetilide (increased risk of QT prolongation)
• Antibacterials such as dapsone (increases plasma levels of both drugs), methenamine (increased risk of crystalluria), and rifampicin (as this can increase plasma rifampicin levels and lower plasma trimethoprim levels)
• Anticoagulants such as warfarin and acenocoumarol - the anticoagulant effect of any drug is enhanced by this combination.
• Sulfonylureas - enhancement of the effect
• Phenytoin, phenytoin half-life increased
• Antifolates such as pyrimethamine, proguanil and methotrexate increase the risk of associated side effects such as bone marrow toxicity, folic acid supplementation should be considered. A significant risk of megaloblastic anemia exists with pyrimethamine doses exceeding 25 mg / wk.
• Antiviral drugs, more specifically, lamivudine (increased plasma concentration of lamivudine), zalcitabine (increased plasma concentration of zalcitabine), and zidovudine (increased risk of hematological reactions)
• Plasma concentrations of procainamide and / or amantadine may increase bilaterally or unilaterally.
• Clozapine and other antipsychotic drugs - increased risk of hematologic side effects
• Nucleoside analogs of anticancer drugs such as azathioprine and mercaptopurine - increased risk of haematological toxicity
• Digoxin - an increase in the level of digoxin in some elderly patients.
• Diuretics - elderly patients receiving thiazide diuretics are at increased risk of thrombocytopenia while taking co-trimoxazole.
• Cyclosporine - Patients who have undergone kidney transplantation and are simultaneously receiving cotrimoxazole and cyclosporine have an increased risk of reversible renal impairment.
• Spironolactone - Concurrent use may increase the likelihood of hyperkalemia, especially in the elderly. Part of the trimethoprim prevents the excretion of potassium in the distal tubules of the nephron.
• Potassium aminobenzoate - the effect of sulfonamides (for example, sulfamethoxazole) is suppressed.
• Laboratory tests; Trimethoprim and sulfonamides have been reported to interfere with diagnostic tests, including serum methotrexate and elevated serum creatinine, as well as tests for urea, urine glucose, and urobilinogen.

Overdose

Possible signs of toxicity include:

• Nausea
• Vomiting
• Dizziness
• Headache
• Mental depression
• Confusion
• Thrombocytopenia
• Uremia
• Bone marrow suppression
• Loss of appetite
• Colic
• Drowsiness
• Unconscious

Recommended treatment for overdose includes:

• Receiving activated carbon
• Pumping stomach
• General support measures
• Hemodialysis, which is moderately effective in removing co-trimoxazole from plasma.
• Calcium folinate treatment for blood dyscrasias
• Forced introduction of liquid into the mouth

Alkalinization of urine may reduce the toxicity of sulfamethoxazole but may increase the toxic effects of trimethoprim.

Pharmacology

Tetrahydrofolate Synthesis Route

Synergism between trimethoprim and sulfamethoxazole was first described in the late 1960s. Trimethoprim and sulfamethoxazole are more effective when taken together than when taken separately because they inhibit sequential steps in the folate synthesis pathway.They are injected into tablets in a ratio of one to five, so that when they enter the body, their concentration in the blood and tissues is about one to twenty - the exact ratio required for maximum synergistic effect between them.

Sulfamethoxazole, a sulfonamide, produces its therapeutic effects by interfering de novo (i.e. within the cell) from the synthesis of folic acid within microbial organisms such as protozoa, fungi and bacteria.It does this by competing with p- aminobenzoic acid (PABA) in dihydrofolate biosynthesis.

Trimethoprim serves as a competitive inhibitor of dihydrofolate reductase (DHFR), thereby inhibiting the synthesis of tetrahydrofolate, a biologically active form of folic acid, de novo .

Tetrahydrofolate plays a critical role in the synthesis of purines, thymidine and methionine, which are essential for the production of DNA and proteins during bacterial replication. Thus, the net effect of each of these drugs is bacteriostatic replication arrest.In combination, TMP and SMX have a bactericidal effect.

The effects of trimethoprim cause dihydrofolate (DHF) lagging, and this lag may work against the inhibitory effect the drug has on tetrahydrofolate biosynthesis; This is where sulfamethoxazole comes to the rescue, its role is to deplete excess DHF, primarily by preventing its synthesis.

Society and culture

Approval

Route

It can be administered orally, as a tablet or suspension, or intravenously.

Trade names

Trimethoprim / sulfamethoxazole may be called SXT, TMP-SMX, TMP-SMZ, or TMP-sulfa.

Co-trimoxazole (BAN) is manufactured and sold by many different companies. The following list of brands is incomplete:

• Bactrim, Bactrimel (produced by Roche and distributed in Europe)
• Bactrom (Venezuela)
• Bibactin (produced by PPM and distributed in Cambodia and some African countries)
• Biseptol
• Co-trimoxazole (Sandoz)
• Cootrim
• Deprim (AFT Pharmaceuticals)
• Disptil (Israel)
• Graprima Forte Kaplet (produced by PT Graha Farma and distributed in Indonesia)
• Infektrin, Bactrim (Brazil)
• Novo-Trimel
• Obtained (Lek in Slovenia and other countries)
• Polytrim
• Resprim
• Sanprima (produced by PT Sanbe Farma and distributed in Indonesia)
• Septra (Aspen Pharmacare and formerly GlaxoSmithKline)
• Septram (Panama)
• Septran (GlaxoSmithKline)
• Septrin (Spain and Malta)
• Sulfatrim
• Teva-Trimel
• Trisul
• Vactrim (produced and distributed in Laos)

Expenses

Trimethoprim / sulfamethoxazole is relatively inexpensive as of 2019.