TMP /SMX

Usual Dosing (Adults)

(IV):
8-10mg/kg/day divided q6-12h.
PCP: 15-20mg/kg/day in 3 or 4 divided doses.

DOSAGE AND ADMINISTRATION
CONTRAINDICATED IN INFANTS LESS THAN 2 MONTHS OF AGE
CAUTION—SULFAMETHOXAZOLE AND TRIMETHOPRIM INJECTION MUST BE DILUTED IN 5% DEXTROSE IN WATER SOLUTION PRIOR TO ADMINISTRATION. DO NOT MIX SULFAMETHOXAZOLE AND TRIMETHOPRIM INJECTION WITH OTHER DRUGS OR SOLUTIONS. RAPID INFUSION OR BOLUS INJECTION MUST BE AVOIDED.

Children and Adults
Pneumocystis Carinii Pneumonia
Total daily dose is 15 to 20 mg/kg (based on the trimethoprim component) given in 3 or 4 equally divided doses every 6 to 8 hours for up to 14 days. One investigator noted that a total daily dose of 10 to 15 mg/kg was sufficient in 10 adult patients with normal renal function.

Severe Urinary Tract Infections And Shigellosis
Total daily dose is 8 to 10 mg/kg (based on the trimethoprim component) given in 2 or 4 equally divided doses every 6, 8 or 12 hours for up to 14 days for severe urinary tract infections and 5 days for shigellosis.

(Oral): Urinary tract infection (adult): 1 DS tab (160mg TMP/800mg SMX) po q12h.

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

Hemodialysis

See above

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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