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Sulfonamides and Trimethoprim Cheat Sheet by

Urinary Tract Infection

Urinary Tract Infect­ions

Drug Class
Folate Antago­nist; Anti-I­nfe­ctive; Antipr­otozoal
Prototype Med
Other Meds
Bactrim and Septra
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


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)

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


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


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
Severely impaired urine creatinine clearance


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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