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Co-trimoxazol

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Co-trimoxazol

Medically reviewed

Laura Arias

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

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Overview of Co-trimoxazol

Property Description
Active Ingredients Sulfamethoxazole (SMX) and Trimethoprim (TMP)
Pharmaceutical Forms Tablet, Oral Suspension, Solution for Intravenous Infusion
Pharmacological Class Antibacterial Agent / Antimicrobial Agent
General Purpose Treatment of susceptible bacterial and protozoal infections
Origin Synthetic

What Type of Medicine is Co-trimoxazol?

Co-trimoxazol is a synthetic antibacterial agent formulated as a fixed-dose combination product designed to combat susceptible infections caused by bacteria and certain protozoa. It is broadly classified within the antimicrobial agent group, a category recognized in global pharmacopoeias. This preparation is distinguished in the anti-infective domain because it consistently merges the actions of two distinct active pharmaceutical ingredients into one preparation. Co-trimoxazol is defined as an anti-infective agent.

Composition and Physical Forms

The medicine is composed of two primary active ingredients: Sulfamethoxazole (SMX) and Trimethoprim (TMP). Sulfamethoxazole belongs to the sulfonamide class, while Trimethoprim is categorized as a folate antagonist; these two structurally different classes work together to enhance efficacy. Co-trimoxazol is available in several common dosage forms, including a tablet and a prepared oral suspension, as well as a sterile solution for intravenous infusion for more acute scenarios. The fixed ratio of these two active substances is used to achieve its combined clinical benefit.

General Purpose: The Synergistic Advantage

The general purpose of Co-trimoxazol is to act as a treatment for a range of systemic and localized bacterial illnesses. This effectiveness stems from its synergistic effect, where the combination of Sulfamethoxazole and Trimethoprim works differently than either agent administered alone. This coordinated dual action is known as sequential blockade and targets the bacterial synthesis of folic acid, which is essential for the pathogen's growth and reproduction. This dual-target mechanism is designed to prevent the replication of pathogens, often resulting in a bactericidal (bacteria-killing) outcome.

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What side effects are possible with Co-trimoxazol?

Possible Side Effects and Safety Information

Co-trimoxazol, a combination of Sulfamethoxazole (SMX) and Trimethoprim (TMP), has an officially documented safety profile categorized by frequency and the body system affected. The most frequently observed adverse effects are typically gastrointestinal disturbances such as nausea and vomiting, alongside various allergic skin reactions.

Official Adverse Reaction Categories

Adverse reactions are classified according to frequency in regulatory documents. Reactions listed as Common (occurring in up to 1 in 10 people) typically include headache, diarrhoea, and skin rashes.

Effects are also grouped by System-Organ-Class, noting possible issues in the Blood and Lymphatic System (e.g., risk of neutropenia or thrombocytopenia), Renal and Urinary Disorders (e.g., crystalluria risk), and Hepatobiliary Disorders.

Serious Adverse Reactions and Safety Constraints

The label documents serious adverse reactions, which, though Very Rare, include life-threatening conditions such as Severe Cutaneous Adverse Reactions (SCARs) like Stevens-Johnson syndrome (SJS) and fulminant hepatic necrosis.

Safety constraints define limitations for use. The medicine is contraindicated in infants less than two months of age and in patients with severe underlying conditions such as severe hepatic damage or megaloblastic anemia due to folate deficiency. Safety notes indicate that the highest risk for SJS/TEN is within the first weeks of treatment and that older patients may be more susceptible to adverse effects.

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Overdose and Emergency Response

The official regulatory profile for Co-trimoxazol overdosage details specific clinical manifestations and mandates immediate emergency action. Acute overexposure is formally documented to present with systemic and CNS signs, including Nausea, Vomiting, Dizziness, Confusion, and Loss of Appetite.

A major concern is the risk of toxicity related to prolonged or high-dose exposure, which may lead to Severe Blood Disorders and Bone Marrow Depression. Clinical signs such as pallor, purpura, or a sore throat may indicate the onset of these serious outcomes.

In the event of suspected overdose, regulatory labeling mandates that immediate medical attention must be sought. Emergency Services (911) must be called urgently if the individual experiences severe events like a seizure, collapse, trouble breathing, or Loss of Consciousness. Contacting a Poison Help Line is also required.

Treatment is symptomatic and supportive, as no specific antidote is formally listed for the main toxicity mechanisms. For documented megaloblastic changes resulting from the trimethoprim component, the official management plan recommends the administration of Leucovorin (Folinic Acid). Continued monitoring of the hematopoietic system is required due to the risk of blood disorders.

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Therapeutic Uses of Co-trimoxazol

Quick Facts

  • Therapeutic Areas: Addresses infections of the urinary tract and respiratory system, and certain gastrointestinal infections.
  • Specific Uses: Used for the management of Pneumocystis pneumonia and in certain cases of traveler's diarrhea.
  • Prophylaxis: May be employed to help prevent specific opportunistic infections in immunocompromised individuals.

What Co-trimoxazol Treats: Main Uses and Benefits

Co-trimoxazol, a combination antimicrobial agent, is primarily indicated for the management of specific bacterial infections that demonstrate susceptibility to its components. Its therapeutic applications focus on several key areas of infection.

The medication is used to address infections affecting the urinary tract, often involving organisms such as Escherichia coli and Klebsiella species. It is also an option for managing acute flare-ups of chronic bronchitis in adults when certain bacteria like Haemophilus influenzae are the cause, particularly when alternative agents are considered less appropriate.

Another significant application is the treatment of traveler's diarrhea in adults due to susceptible enterotoxigenic E. coli strains. Furthermore, the agent is central to the care of documented Pneumocystis pneumonia (Pneumocystis jirovecii pneumonia or PCP) and may be used for prophylaxis (prevention) of this condition in individuals who are immunocompromised. It is also used in the management of shigellosis.

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Eligibility and Restrictions for Use

Co-trimoxazol eligibility is strictly defined by regulatory bodies and is governed by specific patient criteria and underlying health status.

Absolute Non-Eligibility (Contraindications)

Use is strictly contraindicated for patients with a known hypersensitivity to trimethoprim or sulfonamides. The medicine must not be administered to individuals with documented megaloblastic anemia due to folate deficiency, a history of drug-induced immune thrombocytopenia, or known acute porphyria. Absolute prohibitions also apply to patients with marked hepatic damage or severe hepatic failure.

Age and Organ Function Restrictions

The medicine is contraindicated in infants less than two months of age. For adult patients, severe renal insufficiency (CrCl < 15 mL/min) typically constitutes a non-eligibility status, while moderate impairment (CrCl 15 to 30 mL/min) requires a restricted dosage. Particular care is advised when prescribing to older adults due to a higher likelihood of impaired kidney or liver function.

Pregnancy and Lactation Status

Co-trimoxazol is formally contraindicated in women who are nursing/breastfeeding and in pregnant patients at term (late pregnancy) according to regulatory labeling.

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What should I know about interactions with other medicines?

Interactions with other medicines and products

Official regulatory documentation defines specific, clinically significant interaction patterns for Co-trimoxazol (Sulfamethoxazole/Trimethoprim) based on pharmacokinetic and pharmacodynamic mechanisms.

Formal Restrictions and Contraindications

Co-administration is formally contraindicated with Dofetilide, as Co-trimoxazol significantly increases Dofetilide plasma concentrations, raising the risk of severe ventricular arrhythmias. High-dose Co-trimoxazol is also contraindicated with Paclitaxel due to inhibition of Paclitaxel's renal excretion.


Pharmacokinetic and Exposure Modification

Co-trimoxazol alters the metabolism and clearance of several drugs. The combination with Phenytoin results in a marked increase in Phenytoin exposure and prolonged half-life due to metabolic enzyme inhibition. Co-administration with Warfarin potentiates its anticoagulant effect by inhibiting its metabolism, increasing the risk of elevated INR. Trimethoprim inhibits the renal tubular secretion of drugs such as Lamivudine, Procainamide, and Amantadine, leading to increased plasma concentrations of these agents. Exposure to Digoxin can also increase, particularly in the elderly.


Pharmacodynamic and Population-Specific Interactions

Additive effects are documented with other medicines. Combining Co-trimoxazol with Methotrexate or other folate antagonists increases the risk of bone marrow suppression. Co-administration with ACE inhibitors, ARBs, or potassium-sparing diuretics carries a documented risk of additive hyperkalemia. In elderly patients, the combination with thiazide diuretics is noted for an increased risk of thrombocytopenia.

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Mechanism of Action

The core action of Co-trimoxazol involves a sequential blockade targeting two essential enzymes in the pathogenic microorganism: Dihydropteroate Synthase ( DHPS) and Dihydrofolate Reductase ( DHFR). The first component, Sulfamethoxazole, inhibits DHPS through competitive inhibition, while the second, Trimethoprim, inhibits DHFR with high selectivity for the bacterial form. This dual enzymatic interference critically starves the pathogen of active tetrahydrofolic acid ( THF), a necessary co-factor.

This resulting depletion of THF interrupts the vital metabolic cascade required for the synthesis of purine and pyrimidine bases, the building blocks of DNA and RNA. This coordinated action achieves a severe metabolic crisis, resulting in the death of the organism (bactericidal), rather than only growth inhibition (bacteriostatic). The combined action of the two ingredients is synergistic, achieving a level of effect superior to that of either agent administered alone. However, the mechanism's effectiveness is constrained in environments where high concentrations of pre-formed nucleic acid precursors, like thymidine, are present.

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Dosage and Administration Information

How Co-trimoxazol is Used

The usage of Co-trimoxazol follows specific protocols defining the administration route, schedule, duration, and patient-specific adjustments.


Administration Routes and Forms

Co-trimoxazol is administered either orally as a tablet (Regular or Double-Strength) or suspension, or via slow intravenous (IV) infusion using a prepared solution. The IV solution must be diluted immediately before use and administered over a controlled period, typically 60 to 90 minutes, to ensure proper delivery. Rapid injection or bolus administration is not permitted.


Dosing and Schedule Principles

For most acute infections, the standard adult regimen is the Double-Strength tablet taken twice daily (every 12 hours). Treatment for acute issues like traveler's diarrhea typically lasts 5 days, whereas treatment for urinary tract infections is often 10 to 14 days.

In the management of severe infections like Pneumocystis pneumonia (PJP), the dosage is calculated based on the patient's weight, specifically targeting 15 to 20 mg/kg of the Trimethoprim component daily, divided into doses given every 6 to 8 hours. For PJP prophylaxis, a lower dose is commonly given once daily or on three alternating days per week.


Administration Requirements and Adjustments

Oral doses should be taken with a full glass of water to help maintain adequate fluid intake throughout therapy. Dosing must be modified for patients with reduced kidney function; specifically, a 50% dose reduction is necessary when creatinine clearance is between 15 and 30 mL/min. Co-trimoxazol is contraindicated for use in infants less than two months of age.

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Recent Clinical Evidence

Evidence for Pneumocystis Pneumonia (PCP)

The medicine has been studied for both treating and preventing Pneumocystis Pneumonia (PCP), particularly in immunocompromised adults and children. The foundational research is derived from historical Randomized Controlled Trials (RCTs) that monitored outcomes such as survival and symptom resolution. For prevention (prophylaxis), studies monitored the incidence of PCP infection over many months. Findings describe patterns observed in these studies, but evidence is limited for large-scale contemporary trials that compare this regimen against newer options.


Evidence for Acute Bacterial Infections

Research has also examined the use of this medicine for uncomplicated Urinary Tract Infections (UTIs) and acute exacerbations of chronic bronchitis. These trials monitored outcomes like bacteriological cure and symptom improvement, primarily over short-term treatment courses. Research has also explored its use for traveler's diarrhea, but the utility of these findings is increasingly challenged by antimicrobial resistance that data show patterns related to in different geographic regions.


Research in Specific Populations and Long-term Data

Studies have evaluated outcomes in children with HIV infection and older adults with conditions such as UTIs. However, data for certain groups are limited. Follow-up durations were limited in many acute infection studies, meaning long-term effects are not fully established for most indications.


Key Research Gaps and Uncertainties

The evidence base presents limitations, including the historical nature of many core studies. Comparative evidence is lacking in some areas against modern therapeutic standards. Furthermore, findings indicate patterns related to how research results vary widely based on local resistance rates. The evidence quality varies across studies, and research does not determine whether an individual will respond similarly.

Key Studies & References Urinary tract infection (lower): antimicrobial prescribing (NICE Guideline NG109)

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Frequently Asked Questions (FAQ)

Common questions about Co-trimoxazol (FAQ)


Q: Is Co-trimoxazol the same thing as Bactrim or Septra?

A: Co-trimoxazol is the international non-proprietary name (INN) for the medication, which combines sulfamethoxazole and trimethoprim. This combination is marketed under various brand names in different regions, including the trade names Bactrim and Septra.


Q: Can Co-trimoxazol cause stomach upset or nausea?

A: Yes, official safety documents describe gastrointestinal disturbances as being among the most frequently observed adverse effects. Reactions listed as common can include nausea, vomiting, and diarrhea.


Q: Is it common to feel dizzy or lightheaded after taking Co-trimoxazol?

A: Dizziness is mentioned in official product information as a possible nervous system reaction. While the frequency of this specific effect is not always classified in the common categories, it is an effect that has been noted in adverse reaction reports.


Q: Does Co-trimoxazol interact with blood thinners like warfarin?

A: Regulatory documents describe a known interaction between Co-trimoxazol and warfarin, a medication used to reduce blood clotting. Co-trimoxazol may inhibit warfarin's metabolism, which can potentially increase its effect on the body.


Q: What are the official guidelines regarding Co-trimoxazol use in older adults?

A: Official documentation advises that particular care should be exercised when the medicine is prescribed to older adults. This is due to a potential for increased susceptibility to adverse effects, especially if kidney or liver function is impaired.


Q: Can Co-trimoxazol affect my blood sugar levels?

A: Yes, official adverse reaction lists include hypoglycemia (low blood sugar) as a possible metabolic adverse reaction. This effect is noted to occur especially in individuals with pre-existing conditions like diabetes mellitus.


Q: What are the most common conditions Co-trimoxazol is used for?

A: The medicine is generally used to treat a range of susceptible bacterial infections. Official documents describe its use for infections of the urinary tract, the respiratory tract (such as bronchitis), ear infections, and traveler’s diarrhea.


Q: How quickly does Co-trimoxazol usually start to work?

A: Patient-focused information from health authorities suggests that individuals commonly begin to notice an improvement in their infection within two to three days after starting the treatment course.


Q: Does Co-trimoxazol have a specific time of day it should be taken?

A: The standard dosing schedule for acute infections is generally described as being administered twice daily. Regulatory information notes that oral doses may generally be administered without specific regard to meal times.


Q: Is it true that Co-trimoxazol can make you more sensitive to the sun?

A: Yes, official safety constraints mention that taking Co-trimoxazol can increase the skin's sensitivity to the sun. This effect is known as photosensitivity, and caution is advised regarding sun exposure.


Q: Are there any major foods or drinks to avoid while taking Co-trimoxazol?

A: Official advisories note that reducing the intake of high-potassium foods may need to be monitored due to the potential risk of hyperkalemia (high potassium levels). Advisories note that reducing the intake of acidic, spicy, or greasy foods may be mentioned in some literature to potentially lessen the risk of gastrointestinal side effects.


Q: Can Co-trimoxazol affect birth control pills?

A: Reports regarding the failure of oral contraceptives during concurrent use with this medicine are described as controversial in clinical notes. Regulatory patient safety information advises caution and states that appropriate birth control is necessary to prevent pregnancy during therapy.


Q: Can Co-trimoxazol be used in children?

A: The medication is formally indicated for use in children for specific types of infection, including infants older than two months up to 12 years of age. Use in infants under two months is strictly contraindicated in regulatory labeling.


Q: Why is it important to drink lots of water when taking Co-trimoxazol?

A: It is advised to maintain adequate fluid intake during treatment to ensure sufficient urine output. This measure is intended to help prevent the formation of crystals in the urinary tract, a condition known as crystalluria.


Q: Can Co-trimoxazol interact with supplements or vitamins?

A: Yes, the medicine is known to interact with folic acid, a type of B vitamin, by interfering with its synthesis. Official documents recommend that a healthcare provider should be informed about all vitamins, minerals, and supplements being taken.


Q: What are the signs of an allergic reaction to Co-trimoxazol?

A: Official patient information states that the medicine should be discontinued if signs of a reaction appear. These signs may include a rash, fever, cough, chest pain, difficulty breathing, pharyngitis, or yellowing of the skin or eyes (jaundice).


Q: Why are people with G6PD deficiency often told not to take Co-trimoxazol?

A: Regulatory labeling states that in individuals who have G6PD deficiency (glucose-6-phosphate dehydrogenase deficiency), there is a documented risk of hemolysis. Hemolysis is the destruction of red blood cells.


Q: Can Co-trimoxazol cause a yeast infection or thrush?

A: Yes, the official safety profile lists fungal or monilial overgrowth as a common adverse reaction. This condition, which includes yeast infections or thrush, results from changes in the body's natural flora.


Q: Is Co-trimoxazol commonly used for traveler's diarrhea?

A: Official documentation indicates that the medicine is useful in the treatment of traveler's diarrhea. However, its effectiveness may be influenced by local antimicrobial resistance patterns in different geographic regions.


Q: What is the relationship between Co-trimoxazol and Folic Acid?

A: The Trimethoprim component in Co-trimoxazol works by interfering with the synthesis of tetrahydrofolic acid, which is the active form of folic acid. This interference targets a vital process required for the growth of susceptible bacteria.


Q: Can Co-trimoxazol make me feel tired or fatigued?

A: Adverse reaction reports include fatigue (tiredness) and weakness as possible effects of the medicine. These effects are sometimes noted but are not always classified in the common frequency categories.


Q: Why is the drug sometimes given as an intravenous (IV) infusion?

A: The medicine is available in an intravenous (IV) form for use in more acute or severe infections. This route of administration is associated with acute or severe infections where a high initial drug concentration is indicated.


Q: Can I consume alcohol while taking Co-trimoxazol?

A: Official patient advisories note that consuming alcohol while taking this medicine may increase the risk of certain side effects. These potential reactions include flushing, rapid heartbeats, nausea, or vomiting.


Q: Is Co-trimoxazol used to treat acne?

A: Some official clinical guidelines and authoritative resources describe its use as an antibacterial agent for treating acne under certain circumstances. This usage is documented in specific clinical contexts.


Q: Does Co-trimoxazol have a common chemical name in other countries?

A: The drug is comprised of two distinct chemical entities: Sulfamethoxazole and Trimethoprim. Co-trimoxazol is itself the established common International Non-proprietary Name (INN) used by health authorities globally.

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How should Co-trimoxazol be stored and disposed of?

Storage and Disposal of Co-trimoxazole

Co-trimoxazole (Sulfamethoxazole and Trimethoprim) must be stored and disposed of according to specific regulatory requirements to ensure product integrity and public safety.


Storage Requirements

  • Temperature: Store tablets and oral suspension at controlled room temperature, typically 20 C to 25 C (68 F to 77 F). The oral suspension must not be frozen.
  • Protection: The medicine must be protected from light and moisture and kept in a tight, light-resistant container.
  • Stability: The diluted intravenous solution must not be refrigerated and should be used within the stability period specified in the labeling (e.g., 24 hours).
  • Child Safety: All forms must be stored out of the sight and reach of children.

️ Disposal Instructions

Unused or expired Co-trimoxazole must be disposed of in accordance with local regulations, often involving drug take-back programs. The medicine should not be flushed down a toilet or poured down a sink unless specifically directed by the official labeling.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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