Breakpoints

#83 – Dosing Consult: Sulfamethoxazole/trimethoprim

Jul 21, 2023
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INSIGHT

Synergistic MOA and Spectrum

  • Sulfamethoxazole/trimethoprim is a synergistic combination targeting sequential enzymes in folic acid synthesis.
  • It has a broad and unique spectrum, including MRSA, some gram-negatives, fungi, and parasites like pneumocystis and toxoplasmosis.
ADVICE

Dose Based on Trimethoprim Component

  • Dose sulfamethoxazole/trimethoprim based on the trimethoprim component for clarity and safety.
  • Adjust IV doses carefully due to fluid volume and stability concerns, especially in critically ill patients.
ADVICE

Gram-Negative BSI Dosing

  • For uncomplicated gram-negative bloodstream infections, use 5 mg/kg of trimethoprim every 12 hours.
  • This dosage was derived from literature review and clinical practice despite limited solid PKPD data.
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