Urinary Tract Infections
Drug Class |
Folate Antagonist; Anti-Infective; Antiprotozoal |
Prototype Med |
Trimethoprim-Sulfamethoxazole |
Other Meds |
Bactrim and Septra |
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Trimethoprim (Proloprim) |
Sulfamethoxazole is only available in combination with trimethoprim. However, trimethoprim is available by itself under the brand name Proloprim
Therapeutic Use
Uninary Tract Infections |
Pneumocytstis Pneumonia |
Shigella Enteritis (Travelers Diarrhea) |
Chronic bronchitis |
Acute otitis media in children |
Adverse Drug Reactions
Nausea, Vomiting, Anorexia |
Allergic skin reactions |
thrombocytopenia, leukopenia, anemia, agranulocytosis, aplastic anemia |
Superinfection – Clostridium difficile-associated diarrhea (CDAD), Candida infections |
Severe rash, including Stevens-Johnson syndrome |
Kernicterus |
Precautions
Decreased kidney or liver function |
Hypersensitivity to sulfites used as preservatives (wine, foods), other drugs related to sulfonamides (acetazolamide, thiazide diuretics, tolbutamide) |
Suppressed bone marrow |
Clients at risk for megaloblastic anemia (clients with alcoholism, pregnant women, clients who are debilitated) |
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Nursing Interventions
Monitor/Report severe symptoms. |
Monitor for rash and hives. |
Monitor/Report severe diarrhea |
Monitor/Report rash and/or blisters on skin to provider. |
Encourage patient to drink plenty of fluids |
Monitor I & O |
Monitor CBCs and Urinalysis throughout treatment |
Administration
Available as a fixed-dose combination in tablets, liquid solution, and IV form. |
Give oral dose with 8 oz. of water. |
Administer intermittent IV infusion slowly (over 60 to 90 min) and with recommended dilution. |
Drink at least 1,200 to 1,500 mL water/day during treatment with this drug. |
Patient Education
Take with food to minimize GI symptoms. |
Report rash, hives, fatigue, pallor, bruising, or new infections to provider |
Report watery/bloody diarrhea, pain in mouth, difficulty eating, vaginal itching/burning to provider |
Warn clients that sulfonamides decrease the effectiveness of oral contraceptives; use alternate form of contraception. |
Report onset of rash and/or blisters on the skin to provider |
Contraindications
Women who are pregnant or nursing |
Allergy to sulfonamides, trimethoprim, cyclooxygenase-2 inhibitors (celecoxib [Celebrex]) |
Clients with megaloblastic anemia caused by folic acid deficiency |
Children under 2 months |
Pharyngitis caused by group A beta-hemolytic streptococci |
Hyperkalemia |
Severely impaired urine creatinine clearance |
Interactions
Alcohol with the drug may cause a disulfiram-type reaction. |
May increase effects of warfarin, phenytoin, tolbutamide (and other sulfonylurea oral antidiabetic drugs). |
Taken with methotrexate, clients may have increased immunosuppression. |
Reduced effectiveness of oral contraceptives (use alternative contraception). |
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