Urinary Tract InfectionsDrug Class | Folate Antagonist; Anti-Infective; Antiprotozoal | Prototype Med | Trimethoprim-Sulfamethoxazole | 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 UseUninary Tract Infections | Pneumocytstis Pneumonia | Shigella Enteritis (Travelers Diarrhea) | Chronic bronchitis | Acute otitis media in children |
Adverse Drug ReactionsNausea, 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 |
PrecautionsDecreased 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 InterventionsMonitor/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 |
AdministrationAvailable 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 EducationTake 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 |
ContraindicationsWomen 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 |
InteractionsAlcohol 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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