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Active Ingredient: Sulfamethoxazole Trimethoprim.
Oral suspension: 200 mg sulfamethoxazole + 40 mg trimethoprim – active substances.
Additional ingredients: dispersible cellulose, propyl parahydroxybenzoate, methyl parahydroxybenzoate, polysorbate 80, sorbitol, banana and vanilla flavors, purified water.
Tablets: 800 mg sulfamethoxazole + 160 mg trimethoprim – active substances.
Additional ingredients: sodium glycolate starch, povidone, sodium dokuzat, magnesium stearate.
Suspension for oral administration – Bactrim 50 ml or 100 ml per pack, complete with a measuring spoon.
The tablets in the shell – Bactrim Forte 10, 20 or 50 pieces per pack.
♻Pharmacodynamics and pharmacokinetics
Bactrim and Bactrim Forte are bactericidal combination chemotherapeutic drugs that include the active components sulfamethoxazole and trimethoprim (co-trimoxazole), exhibiting a synergistic effect. The mechanism of action of co-trimoxazole is the blocking of two enzymes, which in microorganisms boost the stages of sequential replication of folinic acid. Due to this, bactericidal effects (in vitro) are observed in concentrations at which the active ingredients separately, exhibit only a bacteriostatic effect.
In addition, the effectiveness of co-trimoxazole is much greater than the effect of a single component in relation to pathogens resistant to it. The antibacterial effect of co-trimoxazole (in vitro) covers many pathogenic gram-positive and gram-negative microorganisms.
After oral administration (inside), co-trimoxazole is rapidly and mostly absorbed in the upper part of the gastrointestinal tract.
In the blood reaches Cmax in a period of time from one hour to four. Keeps antibacterial concentration for 7 hours. One day after taking one dose, a small amount of co-trimoxazole is observed in the plasma. Equilibrium concentration is observed after 2–3 days.
Trimethoprim binds to plasma proteins by 44%, and sulfamethoxazole by 70%.
Biotransformation to inactive metabolites occurs in the liver, through acetylation. Distribution in the body runs evenly, with penetration through histohematogenous barriers. In urine and lungs, the concentration of co-trimoxazole exceeds plasma. In the secrets of the prostate and bronchial; saliva; vaginal discharge; in the interstitial, spinal and middle ear fluids; bile; bones; breast milk; eye mucosa accumulates to a lesser extent.
Both active ingredients have the same elimination rate. T1 / 2 increases depending on age: up to 12 months – 7-8 hours, from year to ten – 5-6 hours, in adults – 10-11 hours. With impaired renal function and in the elderly T1 / 2 increases.
They are mainly excreted by the kidneys in a ratio of 10–30% sulfamethoxazole and 50–70% trimethoprim.
♻Indications for use
Respiratory tract: bronchiectasis, croupous pneumonia, pneumocystic pneumonia, bronchitis (chronic and acute), bronchopneumonia.
Urogenital system: urethritis, pyelitis, cystitis, pyelonephritis, lymphogranuloma venereal, epididymitis, prostatitis, gonorrhea (of both sexes), chancroid, inguinal granuloma.
ENT organs: sinusitis, tonsillitis, otitis media, scarlet fever, laryngitis.
Gastrointestinal tract organs: paratyphoid fever, typhoid fever, cholangitis, salmonello carrier, dysentery, cholera, cholecystitis, gastroenteritis, provoked by the enterotoxic strains of Escherichia coli;
Skin: furunculosis, pyoderma, acne, wound infections;
Others: osteomyelitis (chronic and acute) and other osteoarticular infectious diseases, acute brucellosis, malaria (Plasmodium falciparum), South American blastomycosis, toxoplasmosis (in complex treatment).
▶hypersensitivity to co-trimoxazole, other components, including sulfonamides;
▶kidney function failure, with CC less than 15 ml / min;
▶glucose-6-phosphate dehydrogenase deficiency;
▶lactation and pregnancy;
▶age up to 3 months;
▶folic acid deficiency.
Blood formation organs:
➲nausea, passing into vomiting;
➲increased transaminase activity of the liver.
➲infiltrates of the lungs.
➲toxic nephropathy with anuria and oliguria.
➲exudative erythema multiforme (in particular, Stevens-Johnson syndrome);
➲epidermal toxic necrolysis;
➲hyperemia of sclera;
♻ Bactrim, instructions for use (method and dosage)
Suspension Bactrim and Bactrim Forte tablets are taken orally after a meal, the tablets are washed down with water.
Instructions for use Bactrim suspension
Acceptance of Bactrim involves the dosage of the drug by means of a measuring spoon containing 5 ml. Since the age of 12 years, the usual dose of Bactrim is 20 ml in the morning and evening. During long-term therapy, a dose of 10 ml in the morning and 10 ml in the evening is indicated. In severe cases of the disease, it is allowed to take matins and evening doses of 30 ml each.
In the case of acute infections, Bactrim is taken for at least 5 days, or until the time of complete disappearance of symptoms within 2 days. Conducting weekly therapy without signs of improvement in the patient’s condition is a reason for dose adjustment or treatment changes.
In the treatment of soft chancre, Bactrim is prescribed 20 ml twice a day. If there is no healing after 7 days, it is possible to prolong the therapy for the next week. It should be borne in mind that the ineffectiveness of treatment may be associated with resistance of the pathogen.
In the treatment of uncomplicated acute urinary tract infections prescribed to women one-time in the amount of 40-60 ml. Take the suspension is recommended in the evening (at bedtime).
When treating patients undergoing hemodialysis, they take the first normal loading dose of Bactrim, and then proceed to receive half or one third of the usual dose, with a break in a day or two.
In the treatment of pneumonia provoked by Pneumocystis carinii, up to 20 mg of trimethoprim and up to 100 mg of sulfamethoxazole per day per kilogram of body weight are prescribed. Bactrim take two weeks every 6 hours, in equal parts. The maximum dose, with a body weight of 8 kg, is 5 ml and increases by 5 ml for each subsequent 8 kg of weight, respectively. For example, a body weight of 32 kg will require a dose of 20 ml.
In order to prevent pneumonia, provoked by Pneumocystis carinii, patients over the age of 12 years are recommended to take 20 ml of suspension (4 spoons) per day. The children’s daily dose is 150 mg / m2 of trimethoprim and 750 mg / m2 of sulfamethoxazole in two equivalent doses, every week for 3 days in a row. The total dose in 24 hours should not exceed 320 mg of trimethoprim and 1600 mg of sulfamethoxazole.
A newborn from 3 to 5 months is shown morning and evening intake of 2.5 ml of suspension. Children from 6 months to 5 years old morning and evening intake of 5 ml, from 6 to 12 years old morning and evening intake of 10 ml.
In the case of severe infections, the dose can be increased by one and a half times.
With Nocardiosis, it is prescribed in adults 60–80 ml, for 3 months and longer (sometimes up to 1.5 years). The dosage depends on the weight, kidney function, age and severity of the infectious disease.
In case of kidney pathologies of CC 15–30 ml / min, the dose is halved and is not recommended for administration with CC less than 15 ml / min.
♻Instructions for use Bactrim Forte
The usual morning and evening dose for patients after 12 years is 960 mg. When conducting long-term treatment, you can get half of this dose, and in particularly difficult situations, increase the usual dose by one and a half times.
Reception of Bactrim Forte continues for at least 5 days, or until the absence of symptoms within 48 hours. Conducting weekly therapy without signs of improvement in the patient’s condition is a reason for dose adjustment or treatment changes.
In the treatment of soft chancre, 960 mg is prescribed twice a day. If there is no healing after 7 days, it is possible to prolong the therapy for the next week. It should be borne in mind that the ineffectiveness of treatment may be associated with resistance of the pathogen.
In the treatment of uncomplicated acute urinary tract infections, women are prescribed one-time 1920-280 mg. It is recommended to take pills before meals in the evening (at bedtime).
When treating patients undergoing hemodialysis, they take the first normal loading dose of Bactrim Forte, and then proceed to receive half or one third of the usual dose, with a break in a day or two.
In the treatment of pneumonia provoked by Pneumocystis carinii, up to 20 mg of trimethoprim and up to 100 mg of sulfamethoxazole per day in four divided doses are taken, for 2 weeks. The maximum dose, with a body weight of 32 kg, is 960 mg (1 tablet) and increases by 480 mg for every subsequent 16 kg of weight, respectively. For example, a body weight of 48 kg will require a dose of 1440 mg.
In order to prevent pneumonia, provoked by Pneumocystis carinii, patients after the age of 12 years are recommended to take 1 tablet daily (960 mg). Patients under 12 years of age are recommended to take Bactrim suspension.
In Nocardiosis, 3-4 tablets (2880-3840 mg) are prescribed in adulthood for 3 months or longer (sometimes up to 1.5 years). The dosage depends on the weight, kidney function, age and severity of the infectious disease.
In case of kidney pathologies of QA more than 30 ml / min, they take the usual dose of Bactrim Forte, with QC less than 15 ml / min, I do not recommend taking this drug.
♻Is baktrim an antibiotic or not?
Medicines Bactrim and Bactrim Forte are sulfonamides in combination, which, like antibiotics, exhibit an antibacterial effect, but unlike them have a chemical, rather than a natural or semi-synthetic structure. It is due to the combination of sulfamethoxazole and trimethoprim, in relation to susceptible microorganisms, it shows not only a bacteriostatic, but also a bactericidal action, which is not as effective as some antibiotics.
Overdose symptoms manifest as nausea, vomiting, dizziness, intestinal colic, headache, depression, drowsiness, fainting, visual disturbances, confusion, fever, crystalluria and hematuria. Overdose for a long time can lead to leukopenia, thrombocytopenia, jaundice and megaloblastic anemia.
Conduct gastric lavage, internal fluid intake, acidification of urine, in order to enhance the excretion of trimethoprim. Recommended in / m the introduction of 5-15 mg per day of calcium folinata, to eliminate the effects of trimethoprim on the bone marrow. If necessary, conduct hemodialysis.
Bactrim and Bactrim forte, when administered together with indirect anticoagulants, increase their activity and also enhance the effects of Methotrexate and hypoglycemic drugs.
Co-trimoxazole increases the effects of warfarin and phenytoin, as well as reduces the effectiveness of oral contraceptives and tricyclic antidepressants.
Taking Rifampicin affects T1 / 2 trimethoprim in the direction of its reduction.
Diuretics increase the likelihood of thrombocytopenia, and Pyrimethamine, when taken more than 25 mg in 7 days, increases the possibility of megaloblastic anemia.
Combined co-trimoxazole with diuretics and oral hypoglycemic drugs can cause a cross-allergic reaction.
PAS, barbiturates and phenytoin increase the symptoms of folic acid deficiency.
Parallel administration of indomethacin can lead to an increase in the blood concentration of sulfamethoxazole.
Bactrim and Amantadine, when used together, can cause toxic delirium.
When co-trimoxazole is taken, digoxin serum concentration may increase (especially in the elderly).
With co-trimoxazole therapy, dofetilide is contraindicated.
Bactrim – up to 25 ° C.
Bactrim Forte – up to 35 ° C.
Bactrim and Bactrim forte, in unopened packaging, can be stored for 5 years.
In the event of a skin rash or other side effects of a severe nature, treatment with Bactrim must be canceled.
Patients suffering from asthma and prone to allergic reactions, co-trimoxazole is prescribed with extreme caution.
The duration of therapy with co-trimoxazole should be minimal, especially for patients in old age.
Kidney pathologies require a dose adjustment of Bactrim.
During long-term treatment with Bactrim, there is a need to regularly determine the number of formed elements in the blood. With a significant decrease in the number of any of the elements, therapy should be canceled. Patients with severe hematological pathologies can be prescribed co-trimoxazole only in the most extreme cases.
With kidney failure, folic acid deficiency, hematological changes characteristic of folic acid deficiency can be observed in old age. These changes are compensated by the appointment of folic acid.
In the case of long-term use of co-trimoxazole, especially when kidney failure, regular monitoring of urine composition and kidney function is necessary.
In order to prevent crystalluria, it is necessary to provide the body with a sufficient volume of fluid and to follow an adequate diuresis.
Patients with glucose-6-phosphate dehydrogenase deficiency can be prescribed co-trimoxazole only in minimal doses and for absolute reasons.
With proper diet, trimethoprim, disrupting the exchange of phenylalanine, does not affect patients suffering from phenylketonuria.
The appointment of co-trimoxazole requires extreme caution in diseases of the thyroid gland and porphyria.
Patients whose metabolism is “slow acetylation” are more susceptible to idiosyncrasy to sulfonyl amides.
Bactrim and Bactrim Forte are contraindicated for children up to 3 months, at a different age are prescribed according to the recommendations for use.
♻During pregnancy (and lactation)
Co-trimoxazole preparations are contraindicated during lactation and pregnancy.
♻ Reviews Bactrim
Different people who took these drugs, put aside the opposite reviews about Bactrim and Bactrim forte. For some, these drugs have become a great helper; for others, their intake turned out to be only side effects. It is worth noting that co-trimoxazole preparations indeed have many contraindications and a rather significant list of side effects, in connection with which, their purpose is advisable only in the case of reliable indications taking into account the history and reactions of the individual patient.
For children, reviews of Bactrim suspension are also varied and do not provide an opportunity to form an unequivocal opinion about its effectiveness and safety. The only conclusion that can be made by examining parents reviews is that only an experienced doctor should prescribe this drug, after conducting various tests and studies, and only in this case therapy will be effective and relatively safe.