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## Overview
Septran is a brand name for co-trimoxazole, a combination antibiotic containing trimethoprim and sulfamethoxazole.
## Primary Indications
* Urinary tract infections (UTIs)
* Pneumocystis jirovecii pneumonia (PCP) prophylaxis and treatment
* Acute exacerbations of chronic bronchitis
* Shigellosis gastroenteritis
* Other susceptible bacterial infections
## Adult Dosing
* **UTIs and most other infections:** 160 mg trimethoprim/800 mg sulfamethoxazole (1 double-strength tablet) every 12 hours.
* **PCP Treatment:** 160 mg trimethoprim/800 mg sulfamethoxazole every 6 hours for 14-21 days.
* **PCP Prophylaxis:** 160 mg trimethoprim/800 mg sulfamethoxazole once daily, or 160 mg trimethoprim/800 mg sulfamethoxazole three times weekly.
* **Shigellosis:** 160 mg trimethoprim/800 mg sulfamethoxazole every 12 hours for 5 days.
Maximum daily dose is typically 4 double-strength tablets.
## Pediatric Dosing
Dosing is based on trimethoprim component, usually 8 mg/kg/day divided into two doses.
* **General Infections:** 8 mg/kg/day of trimethoprim (equivalent to approximately 40 mg/kg/day of co-trimoxazole) given in two divided doses every 12 hours.
* **PCP Treatment:** 20 mg/kg/day of trimethoprim (equivalent to approximately 100 mg/kg/day of co-trimoxazole) divided into four doses every 6 hours for 14-21 days.
* **PCP Prophylaxis:** 5 mg/kg/day of trimethoprim (equivalent to approximately 25 mg/kg/day of co-trimoxazole) given in two divided doses every 12 hours, or 150 mg/m²/day of trimethoprim given in two divided doses.
Dosing should not exceed the adult maximum dose.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No adjustment necessary.
* CrCl 15-30 mL/min: Half of the usual recommended dose.
* CrCl < 15 mL/min: Not recommended.
## Contraindications
* Known hypersensitivity to trimethoprim or sulfonamides.
* Documented megaloblastic anemia due to folate deficiency.
* Infants less than 2 months of age (risk of kernicterus).
* Severe renal or hepatic insufficiency.
* History of drug-induced thrombocytopenia with sulfonamides or trimethoprim.
## Adverse Effects
* **Common:** Rash, nausea, vomiting, diarrhea.
* **Serious:** Stevens-Johnson syndrome, toxic epidermal necrolysis, severe hypersensitivity reactions, blood dyscrasias (anemia, thrombocytopenia, leukopenia, agranulocytosis), hyperkalemia, renal damage, photosensitivity.
## Key Drug Interactions
* **Warfarin:** Increased INR; monitor INR closely and adjust warfarin dose as needed.
* **Methotrexate:** Increased risk of methotrexate toxicity; avoid or monitor for toxicity.
* **ACE inhibitors and ARBs:** Increased risk of hyperkalemia.
* **Potassium-sparing diuretics:** Increased risk of hyperkalemia.
* **Procainamide and Amantadine:** Increased serum levels and risk of toxicity.
* **Digoxin:** Increased digoxin levels, especially in patients with renal impairment.
## Monitoring
* Renal function (BUN, creatinine).
* Electrolytes (especially potassium).
* Complete blood counts (CBC) with differential and platelet count, particularly with prolonged therapy or in immunocompromised patients.
* Liver function tests if clinically indicated.
* Signs and symptoms of hypersensitivity reactions and skin reactions.
## Clinical Pearls
* Administer with a full glass of water to minimize crystalluria.
* Encourage increased fluid intake to prevent crystalluria.
* Advise patients to report any rash, sore throat, or fever immediately.
* Discontinue drug immediately if rash develops.
* Use with caution in patients with G6PD deficiency due to risk of hemolytic anemia.
* Sulfonamides can displace bilirubin from albumin, potentially leading to kernicterus in newborns; avoid use in late pregnancy.
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This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines before making any treatment decisions.
