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# Septran (Co-Trimoxazole)
## Overview
Septran is a combination antibiotic containing trimethoprim and sulfamethoxazole.
## Primary Indications
* Urinary tract infections (UTIs)
* Pneumocystis jirovecii pneumonia (PJP) prophylaxis and treatment
* Acute exacerbations of chronic bronchitis
* Shigellosis
* Traveler's diarrhea
## Adult Dosing
Dosing varies based on indication and severity. A common regimen for uncomplicated UTIs is 160 mg trimethoprim/800 mg sulfamethoxazole (1 double-strength tablet) every 12 hours for 3-7 days. For PJP treatment, 15-20 mg/kg/day of trimethoprim component, divided into 3-4 doses, for 14-21 days.
## Pediatric Dosing
Dosing is based on the trimethoprim component, typically 5-10 mg/kg/day administered in two divided doses for UTIs. For PJP treatment, 15-20 mg/kg/day of trimethoprim component, divided into 3-4 doses, for 14-21 days.
## Dose Adjustments
Reduce dose in moderate to severe renal impairment. Specific recommendations vary; consult renal dosing guidelines.
## Contraindications
* Hypersensitivity to trimethoprim or sulfonamides
* History of drug-induced thrombocytopenia with sulfonamides or trimethoprim
* Megaloblastic anemia due to folate deficiency
* Premature infants and term infants during the first 2 months of life (risk of kernicterus)
## Adverse Effects
Common: Rash, nausea, vomiting, diarrhea.
Serious: Stevens-Johnson syndrome/toxic epidermal necrolysis, hypersensitivity reactions, bone marrow suppression (anemia, leukopenia, thrombocytopenia), hyperkalemia, renal impairment, phototoxicity.
## Key Drug Interactions
* **Warfarin:** Increased INR. Monitor INR closely.
* **Methotrexate:** Increased methotrexate levels.
* **ACE Inhibitors/ARBs/Potassium-Sparing Diuretics:** Increased risk of hyperkalemia.
* **Sulfonylureas:** Potentiated hypoglycemic effect.
* **Rifampin:** May decrease levels of trimethoprim.
## Monitoring
* Renal function
* Complete blood counts (CBC) with differential, especially with prolonged therapy or in immunocompromised patients.
* Electrolytes, particularly potassium.
* Signs of hypersensitivity reactions.
## Clinical Pearls
* Adequate fluid intake is essential to prevent crystalluria.
* Caution in patients with G6PD deficiency.
* Consider folate supplementation, especially with prolonged therapy or in folate-deficient individuals.
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*Please verify current prescribing information with the manufacturer's product monograph or other reliable sources before dispensing.*
