iv bag
BACTRIM ® - (trimethoprim /sulfamethoxazole)
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents
D5W

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]
[0 to 80 mg] [100 ml] [60 min]
[81 to 120 mg] [150-250 ml] [90 min]
[121 to 240 mg] [250 ml] [90 min]
[241 to 450 mg] [500 ml] [2 hours]


Minimum dilution: 80 mg TMP/ 75 ml.

Stability / Miscellaneous
EXP: 6 hours (RT) / 2hours (minimum dilution)
Label: Do not Refrigerate
Minimum dilution: 80 mg TMP/ 75 ml.

Non-PCP: 10mg/kg/day ( based on TMP component) divided q6h or q8h or q12h.
PCP: 15-20mg/kg/day (based on TMP component) divided q6h.

Renal Dosing -------------------------------------------------------------------------
Package Insert --------------------------------------------------------------
Patients who receive cotrimoxazole intravenously or orally and have impaired renal function should be dosed according to the following dosage schedule:
Creatinine Clearance Dosage (mL/min)

Above 30: Standard regimen
15-30: 1/2 standard regimen
Below 15: Not recommended


Non-PCP:
[>30 ml/min]: no change
[15-30]: 2.5 mg/kg q12h
[<15 ml/min]: not recommended by manufacturer.

Alternative (LESS SUPPORT): 2.5mg/kg q24h (Avoid if possible due to risk of crystalluria/ nephrolithiasis)

PCP:
[>30 ml/min]: no change
[15-30]: 5mg/kg q12h
[<15 ml/min]: not recommended by manufacturer.

Alternative (LESS SUPPORT): 5mg/kg q24h (Avoid if possible due to risk of crystalluria/ nephrolithiasis)

Hemodialysis:
Not recommended by manufacturer.
Alternative (LESS SUPPORT):
Oral: Avoid if possible. If unavoidable, give one SS/DS q24h.
IV: Avoid if possible. If unavoidable, give 5mg/kg q24h.


------------Micromedex --------------------------------------------------------------
Guidelines for the administration of cotrimoxazole (based on the trimethoprim component) in patients with renal dysfunctions (Paap & Nahata, 1995; Paap & Nahata, 1989):

INDICATION/RENAL FUNCTION DOSE
PCP TREATMENT
CrCl > than 30 ml/min
15-20 mg/kg/day divided q6-8h

CrCl 15 to 30 ml/min
15-20 mg/kg/day divided q6-8h for 48h then 7-10 mg/kg/day divided q12h

CrCl < 15 ml/min
15-20 mg/kg/dose q48h (or 7-10 mg/kg/day divided q12-24h)

Hemodialysis
15-20 mg/kg/dose before dialysis and 7-10 mg/kg/dose after dialysis

PCP PROPHYLAXIS
CrCl > 30 ml/min
5 mg/kg q24h for 3 to 7 doses/week

CrCl 15 to 30 ml/min
5 mg/kg q24-48h for 3 to 7 doses/week

CrCl < 15 ml/min
5 mg/kg q48-72h

Hemodialysis
5 mg/kg after dialysis

OTHER INFECTIONS
CrCl greater than 30 ml/min
8-12 mg/kg/day divided q12h for 14 days then 4-6 mg/kg q24h

CrCl 15 to 30 ml/min
8-12 mg/kg/day divided q12h for 1-2 days then 4-6 mg/kg/day q24h

CrCl less than 15 ml/min
8-12 mg/kg/dose q48h (or 4-6 mg/kg/day divided q12-24h)

Hemodialysis
8-12 mg/kg/dose before dialysis and 4-6 mg/kg/dose after dialysis


The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.