Please check your internet connection and try again.
## Septran (Co-trimoxazole)
### Overview
Septran is a combination antibiotic containing sulfamethoxazole and trimethoprim. It is a bacteriostatic agent that inhibits folic acid synthesis.
### Primary Indications
* Urinary tract infections (UTIs)
* Pneumocystis jirovecii pneumonia (PJP) prophylaxis and treatment
* Acute otitis media
* Acute exacerbations of chronic bronchitis
* Shigellosis gastroenteritis
### Adult Dosing
* **UTIs/Acute Otitis Media/Chronic Bronchitis Exacerbations:** 160 mg trimethoprim / 800 mg sulfamethoxazole (1 DS tablet) orally twice daily for 3-14 days depending on indication.
* **PJP Treatment:** 15-20 mg/kg/day of trimethoprim component, divided into 3-4 doses orally or IV for 14-21 days.
* **PJP Prophylaxis:** 1 DS tablet orally once daily, or 1 DS tablet orally three times a week.
### Pediatric Dosing
* **UTIs/Acute Otitis Media:** 8-10 mg/kg/day of trimethoprim component, divided into two doses, given every 12 hours.
* **Example:** For a 20 kg child, the dose would be 160-200 mg of trimethoprim per day, divided into two doses of 80-100 mg each.
* **PJP Treatment:** 15-20 mg/kg/day of trimethoprim component, divided into 3-4 doses orally or IV for 14-21 days.
* **PJP Prophylaxis:** 150 mg/m²/day of trimethoprim component, divided into two doses, given orally once daily.
### Dose Adjustments
* **Renal Impairment:**
* CrCl > 30 mL/min: No adjustment needed.
* CrCl 15-30 mL/min: Give usual dose every 12-18 hours.
* CrCl < 15 mL/min: Avoid use or give half the usual dose every 18-24 hours.
### Contraindications
* Hypersensitivity to trimethoprim or sulfonamides.
* Infants younger than 2 months.
* Marked anemia, megaloblastic anemia due to folate deficiency.
* Severe renal or hepatic insufficiency where urine or blood concentration cannot be monitored.
### Adverse Effects
* **Common:** Nausea, vomiting, rash, pruritus, diarrhea.
* **Serious:** Severe hypersensitivity reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis), hematologic abnormalities (anemia, leukopenia, thrombocytopenia, agranulocytosis, megaloblastic anemia), hyperkalemia, renal failure, liver injury.
### Key Drug Interactions
* **Warfarin:** Increased INR. Monitor INR closely.
* **Methotrexate:** Increased methotrexate levels and toxicity.
* **ACE inhibitors/ARBs/Potassium-sparing diuretics:** Increased risk of hyperkalemia.
* **Digoxin:** May increase digoxin levels.
* **Tricyclic Antidepressants:** May decrease efficacy.
### Monitoring
* Complete blood counts (CBCs) with differential at baseline and periodically during therapy, especially in prolonged treatment or high-risk patients.
* Renal function (BUN, creatinine).
* Electrolytes (especially potassium).
* Liver function tests.
* Monitor for signs of hypersensitivity reactions.
### Clinical Pearls
* Encourage adequate fluid intake to prevent crystalluria.
* Take with food or milk to minimize gastrointestinal upset.
* Caution in patients with G6PD deficiency due to risk of hemolytic anemia.
* Consider folic acid supplementation (5-10 mg daily) in patients on prolonged therapy to prevent hematologic complications.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for complete details before making clinical decisions.*
