Please check your internet connection and try again.
# Septran (Co-trimoxazole)
## Overview
Septran is a combination antibiotic of trimethoprim and sulfamethoxazole. It is available in various formulations, including oral tablets and suspensions, and intravenous preparations.
## Primary Indications
* Treatment of urinary tract infections (UTIs) caused by susceptible organisms.
* Treatment of *Pneumocystis jirovecii* pneumonia (PJP).
* Treatment and prophylaxis of *Pneumocystis jirovecii* pneumonia in immunocompromised patients.
* Treatment of traveler's diarrhea caused by susceptible organisms.
* Treatment of otitis media in children.
## Adult Dosing
* **Urinary Tract Infections (Uncomplicated):** 1 DS (double-strength) tablet every 12 hours for 3-7 days.
* **Urinary Tract Infections (Complicated):** 1 DS tablet every 12 hours for 10-14 days.
* ***Pneumocystis jirovecii* Pneumonia (Treatment):** 15 mg/kg (trimethoprim component) per day divided into 3-4 doses, IV or PO, for 14-21 days. A common oral regimen is 2 DS tablets every 8 hours.
* ***Pneumocystis jirovecii* Pneumonia (Prophylaxis):** 1 DS tablet once daily, or 1 DS tablet three times a week.
* **Traveler's Diarrhea:** 1 DS tablet every 12 hours for 5 days.
## Pediatric Dosing
* **Urinary Tract Infections:** 8 mg/kg (trimethoprim component) per day divided into two doses, PO.
* ***Pneumocystis jirovecii* Pneumonia (Treatment):** 15 mg/kg (trimethoprim component) per day divided into 3-4 doses, IV or PO, for 14-21 days.
* ***Pneumocystis jirovecii* Pneumonia (Prophylaxis):** 150 mg/m² (trimethoprim component) per day divided into two doses, PO, given on 3 consecutive days per week or as 1 DS tablet once daily.
Dosing for children over 12 years of age is generally the same as adults.
## Dose Adjustments
* **Renal Impairment:** Adjust dose based on creatinine clearance (CrCl).
* CrCl > 30 mL/min: Standard dose.
* CrCl 15-30 mL/min: Half the standard dose.
* CrCl < 15 mL/min: Avoid use.
* **Hepatic Impairment:** Use with caution; no specific dose adjustments are established, but monitor liver function.
## Contraindications
* Documented hypersensitivity to trimethoprim or sulfonamides.
* Severe renal insufficiency (CrCl < 15 mL/min).
* Infants less than 2 months of age (due to risk of kernicterus).
* Megaloblastic anemia due to folate deficiency.
* History of drug-induced thrombocytopenia with sulfonamides or trimethoprim.
## Adverse Effects
* **Common:** Rash, nausea, vomiting, diarrhea, hyperkalemia.
* **Serious:** Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), aplastic anemia, agranulocytosis, severe hypersensitivity reactions, hepatotoxicity, crystalluria, hyperkalemia.
## Key Drug Interactions
* **Warfarin:** Increased INR. Monitor INR closely and adjust warfarin dose.
* **ACE Inhibitors/ARBs:** Increased risk of hyperkalemia. Monitor potassium levels.
* **Potassium-Sparing Diuretics:** Increased risk of hyperkalemia. Avoid concurrent use if possible.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **Digoxin:** Increased digoxin levels, especially in elderly patients.
* **Cyclosporine:** Increased cyclosporine levels and nephrotoxicity.
* **Oral Contraceptives:** May reduce efficacy. Advise alternative contraception.
## Monitoring
* **Renal function:** Monitor SCr and CrCl, especially in patients with pre-existing renal disease.
* **Electrolytes:** Monitor potassium levels, particularly in patients with renal impairment or those taking other medications that affect potassium.
* **Complete Blood Count (CBC):** Monitor periodically, especially with prolonged therapy, to detect hematologic abnormalities.
* **Liver function tests:** Monitor if hepatic impairment is present or if signs of hepatotoxicity develop.
* **Hydration:** Ensure adequate fluid intake to prevent crystalluria.
## Clinical Pearls
* Co-trimoxazole can cause pseudohyperkalemia.
* Advise patients to drink plenty of fluids while taking this medication.
* Rash can occur at any time during therapy, even after completion; advise patients to report any rash immediately.
* Photosensitivity can occur; advise patients to use sun protection.
* It is generally recommended to take oral co-trimoxazole with food or milk to minimize gastrointestinal upset.
***
**Disclaimer:** This information is intended for clinical use and is not exhaustive. Always consult the most current prescribing information and relevant literature for complete details and to ensure patient-specific appropriateness.
