Co-trimoxazole review

Co-trimoxazole has shown that two can indeed be better than one especially when it comes to fighting infectious bacteria. The drug is very effective but there are also a number of side effects to watch out for.

Co-trimoxazole is the generic name of the antibiotic combination of sulfamethoxazole and trimethoprim. The drug is divided in a ratio of 5:1 (sulfamethoxazole and trimethoprim respectively) and is primarily used for the treatment of various bacterial infections. The drug is also available under brand names such as Septrin, Bactrim, Cotrim, Septra, Sulfatrim and Bethaprim.

Co-trimoxazole is frequently used to treat simple infections and is available in tablet, injection and liquid form. It shows a synergistic antibacterial effect due to the combined actions of the two known agents. The two agents exhibit progression in the folate synthesis pathway especially when combined in the 5 is to 1 ratio. Co-trimoxazole may also be indicated for treating more advanced bacterial infections.

The medication is indicated for the treatment of pneumocystis pneumonia, chronic bronchitis, urinary tract infection, acute otitis media in children, skin and wound infection, gastrointestinal tract infection, shigellosis, traveller’s diarrhea, Whipple’s disease, cerebral toxoplasmosis in HIV patients and melioidosis.

The drug can also cause various side effects and due to the severity of some, co-trimoxazole has been withdrawn in some areas. Included are anemia or blood disorders, allergic reactions, bluish lips and fingernails, breathing difficulties, palpitations, arrhythmia, fever, sorethroat, chills, joint and muscle pain, sensitivity to sunlight or ultraviolet light, skin redness or blistering, fatigability and jaundice. Less serious side effects are dizziness, headache, loss of appetite, nausea and vomiting.

Those with known hypersensitivity reaction to the drug are contraindicated. Individuals with neutropenia, agranulocytosis, aplastic anemia, megaloblastic anemia and thrombocytopenia should not take co-trimoxazole. Doctors should be aware if patients have history of kidney or liver disease, high levels of potassium in the blood, porphyria and glucose-6-phosphate dehydrogenase or G6PD deficiency. Pregnant and breastfeeding women should be cautious as well. Co-trimoxazole is known to interact with drugs such as digoxin, rifampin, phenytoin, diabetes medications, amiloride, methotrexate, warfarin, valproic acid and potassium salts so medical consultation is needed before consumption.

Sulfamethoxazole is a false-substrate inhibitor of dihydropteroate synthetase. The agent is an analogue of p-aminobenzoic acid or PABA which aggressively inhibits the enzyme to limit dihydropteroic acid production. Trimethoprim interferes with bacterial dihydrofolate reductase action to limit tetrahydrofolic acid synthesis. The combination of the two agents is highly synergic in eliminating bacteria by preventing them from growing and spreading.

12 patients suffering from skin infection were included in a study comparing co-trimoxazole and penicillin. 6 patients were given 250 mg of co-trimoxazole every 6 hours while the other group of 6 was provided with 250 mg of penicillin every 6 hours. After the first week, all 12 patients showed improvement in symptoms and by the second week were fully recovered. However, 2 of the 6 patients who took co-trimoxazole presented mild side effects such as skin redness. None from the penicillin group were affected.

Co-trimoxazole is an over-the-counter or OTC medication which can be bought at designated pharmacies and online drugstores. Consumers need to verify authenticity of the product through labels, certification and manufacturing source. The quality and expiry date should also be checked to ensure freshness.

Only take the recommended dosage and never double if one dose is missed. Take the missed dose as soon as possible. Observe for symptoms of overdose as well. Continue taking the drug even if symptoms of infection have disappeared to avoid tolerance. Keep the medicine in room temperature away from heat, moisture and children’s reach.

Co-trimoxazole has the following structural formula:

Chemical structure of co-trimoxazole

• Molecular formula of co-trimoxazole is C14H18N4O3
• Chemical IUPAC Name is 5-[(3,4,5-trimethoxyphenyl)methyl]pyrimidine-2,4-diamine
• Molecular weight is 290.318 g/mol
Co-trimoxazole available : 400-80mg tablets

Generic name: Trimethoprim

Brand name(s): Abacin, Abaprim, Alprim, Apo-Sulfatrim, Bactin, Bactramin, Bactrim, Bactrim Ds, Baktar, Chemotrim, Comox, Cotrim, Drylin, Eusaprim, Fectrim, Gantaprim, Gantrim, Idotrim, Imexim, Instalac, Ipral, Kepinol, Laratrim, Lidaprim, Linaris, Methoprim, Microtrim, Monoprim, Monotrim, Monotrimin, Nopil, Oraprim, Priloprim, Primosept, Primsol, Proloprim, Septra, Septra Ds, Septrin, Sigaprim, Sulfamethoprim, Sulfatrim, Sulfatrim-Ds, Sulfatrim-Ss, Sulfotrim, Sulmeprim, Sulprim, Sumetrolim, Supracombin, Suprim, Syraprim, Teleprim, Thiocuran, Tiempe, Trigonyl, Trimanyl, Trimesulf, Trimethioprim, Trimethopriom, Trimetoprim, Trimexazole, Trimogal, Trimopan, Trimpex, Triprim, Unitrim, Uretrim, Uro-Septra, Uroplus, Uroplus Ds, Uroplus Ss, Veltrim, Wellcoprim

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