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# Septran (Co-trimoxazole)
## Overview
Co-trimoxazole is a combination antibiotic of trimethoprim and sulfamethoxazole.
## Primary Indications
* Urinary tract infections (UTIs)
* Pneumocystis jirovecii pneumonia (PJP) prophylaxis and treatment
* Bacterial respiratory tract infections
* Bacterial gastrointestinal infections
## Adult Dosing
* **UTIs:** 160 mg trimethoprim/800 mg sulfamethoxazole (1 DS tablet) every 12 hours for 3-7 days.
* **PJP Prophylaxis:** 1 DS tablet once daily or 1 DS tablet three times weekly.
* **PJP Treatment:** 15 mg/kg/day trimethoprim component (divided into 4 doses) or 1 DS tablet every 6 hours for 14-21 days. Maximum 960 mg trimethoprim component daily.
* **Other Infections:** Dosing varies significantly by indication. Often 1 DS tablet every 12 hours. Severe infections may require 2 DS tablets every 12 hours.
## Pediatric Dosing
Dosing is based on the trimethoprim component, typically 8-10 mg/kg/day divided into two doses. Refer to specific guidelines for PJP prophylaxis (e.g., 75 mg/m²/day trimethoprim component divided into two doses) and treatment.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is necessary based on creatinine clearance. Consult specific guidelines.
## Contraindications
* Known hypersensitivity to trimethoprim or sulfonamides
* Documented megaloblastic anemia due to folate deficiency
* Premature infants and infants < 2 months old (risk of kernicterus)
* Severe renal or hepatic insufficiency when clinical and laboratory monitoring is not possible
* Porphyria
## Adverse Effects
Common: Rash, nausea, vomiting, diarrhea, hyperkalemia.
Serious: Severe cutaneous adverse reactions (e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis), blood dyscrasias (anemia, thrombocytopenia, neutropenia), hepatotoxicity, renal impairment, photosensitivity.
## Key Drug Interactions
* Potentiates warfarin effect (increased INR)
* May increase serum levels of phenytoin, digoxin, and methotrexate
* Increased risk of hyperkalemia with ACE inhibitors, ARBs, potassium-sparing diuretics, and potassium supplements.
* Can increase serum levels of cyclosporine.
## Monitoring
* Renal function (creatinine)
* Complete blood count (CBC)
* Electrolytes, especially potassium
* Liver function tests (LFTs)
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Administer with food or milk to minimize gastrointestinal upset.
* Ensure adequate fluid intake to prevent crystalluria.
* Monitor for rash, which can be a sign of a severe reaction.
* TMP/SMX is a common cause of drug-induced fever.
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*This information is intended for healthcare professionals. Always verify current prescribing information and local protocols before administering medication.*
