Cotrimoxazole

The recommended daily dosage of cotrimoxazole injection in adults and pediatric patients (two months of age and older) by indication is as follows:

• Pneumocystis jirovecii Pneumonia: Total daily dose (based on trimethoprim content) is 15-20 mg/kg (in 3 or 4 equally divided doses), given every 6 to 8 hours for a duration of 14 days.
• Shigellosis: Total daily dose (based on trimethoprim content) is 8-10 mg/kg (in 2 to 4 equally divided doses) given every 6, 8 or 12 for a duration of 5 days.
• Severe Urinary Tract Infections: Total daily dose (based on trimethoprim content) is 8-10 mg/kg (in 2 to 4 equally divided doses), given every 6, 8 or 12 hours for a duration of 14 days.

Administer the solution by intravenous infusion over a time-span of 60-90 minutes. Avoid administration of this medication by rapid infusion or bolus injection. Do not administer trimethoprim sulfamethoxazole injection intramuscularly.

The most commonly reported side effects due to Cotrimoxazole include: gastrointestinal disturbances (vomiting, nausea, and anorexia) and allergic skin reactions (such as rash and urticaria).

• Some epidemiologic assessments suggest that exposure to Cotrimoxazole during pregnancy may be associated with an increased risk of congenital malformations, mainly cardiovascular malformations, urinary tract defects, neural tube defects, oral clefts, and club foot.
• Cotrimoxazole-induced thrombocytopenia may be an immune-mediated disorder. Serious cases of thrombocytopenia that are life threatening or fatal have occurred. Patients need to be monitored for hematologic toxicity. Thrombocytopenia typically resolves within a week upon interruption of Cotrimoxazole.
• Avoid use of trimethoprim sulfamethoxazole in patients with impaired renal or hepatic function, in those with probable folate deficiency (e.g., the elderly, chronic alcoholics, patients with malabsorption syndrome, patients receiving anticonvulsant therapy, and patients in malnutrition states) and in those with severe allergies or bronchial asthma.
• Cases of hypoglycemia in non-diabetic patients treated with Cotrimoxazole have been noted, typically occurring after some days of therapy. Patients with liver disease, renal dysfunction, malnutrition or those receiving high doses of Cotrimoxazole are mainly at risk.
• Like other medicines containing sulfonamides, Cotrimoxazole can precipitate porphyria crisis and hypothyroidism. Avoid the use of Cotrimoxazole in patients with porphyria or thyroid dysfunction.
• Local irritation and inflammation because of the extravascular infiltration of the infusion have emerged with trimethoprim sulfamethoxazole injection. If these emerge the infusion should be interrupted and restarted at another site.
• Complete blood counts (CBC) and clinical chemistry testing should be performed frequently in patients receiving Cotrimoxazole. Perform urinalysis with precise microscopic assessment and renal function tests during therapy, mainly for those with impaired renal function.

Store the vials of Cotrimoxazole or Trimethoprim/Sulfamethoxazole at room temperature (15°C to 30°C or 59°F to 86°F). It is not recommended to refrigerate this medicinal product.