Drug Information: Indications, Side Effects, Warnings
Combined antimicrobial substance
Description of the active substance :
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Combination antimicrobial agent consisting of trimethoprim-sulfamethoxazole and. Sulfamethoxazole, which is similar in structure to PABA, violates the synthesis of dihydrofolic acid in bacterial cells, preventing the incorporation of PABA in its molecule. Trimethoprim sulfamethoxazole enhances the action, violating recovery dihydrofolic acid to tetrahydrofolic — the active form of folic acid, which is responsible for protein metabolism and microbial cell division. Is a broad spectrum germicide action, is active against the following organisms: Streptococcus spp, Staphylococcus spp., Streptococcus pneumoniae, Neisseria meningitidis, Neisseria gonorrhoeae, Salmonella spp, Bordetella pertussis, Proteus spp., Pasteurella spp., Brucella spp., Mycobacterium spp., Legionella pneumophila, Morganella spp., Pneumocystis carinii; Chlamydia spp .; protozoa: Plasmodium spp., Leishmania spp. Drug resistance: Corynebacterium spp., Pseudomonas aeruginosa, Mycobacterium tuberculosis, Treponema spp., Leptospira spp., Viruses. Inhibits vital activity of Escherichia coli, which leads to reduced synthesis of thymine, riboflavin, nicotinic acid and other. B vitamins in the intestine. The duration of the therapeutic effect of 7 hours.
Infection urinary organs: urethritis, cystitis, pyelitis, pyelonephritis, prostatitis , gonorrhea (male and female), lymphogranuloma venereum, granuloma inguinale; respiratory tract infections: bronchitis (acute and chronic), bronchiectasis, lobar pneumonia, bronchopneumonia, Pneumocystis pneumonia; of upper respiratory tract infections: otitis media, sinusitis, laryngitis, sore throat; scarlet fever; gastrointestinal infections: typhoid, cholera, dysentery, cholangitis, gastroenteritis; infections of skin and soft tissue: acne, furunculosis, wound infections; osteomyelitis (acute and chronic), and others.
Hypersensitivity (including to sulfonamides), liver and / or renal insufficiency (creatinine clearance less than 15 ml / min), aplastic anemia, B12-deficiency anemia, agranulocytosis, leukopenia, deficiency of glucose-6-phosphate dehydrogenase, pregnancy, lactation, Pneumocystis pneumonia and up to 6 years (for the / m), children’s age (up to 3 months — for oral administration), hyperbilirubinemia in babies. C caution. Folic acid deficiency, asthma, thyroid disease.
From the nervous system: headache, dizziness; in some cases — aseptic meningitis, depression, apathy, peripheral neuritis. The respiratory system: bronchospasm, pulmonary infiltrates. From the digestive system: loss of appetite, diarrhea, gastritis, stomatitis. From the side of hematopoiesis: leukopenia, thrombocytopenia, agranulocytosis. From the urinary system: interstitial nephritis, increasing concentrations of urea, toxic nephropathy with oliguria and anuria. On the part of the musculoskeletal system: arthralgia, myalgia. Allergic reactions: photosensitivity, erythema multiforme exudative (including Stevens-Johnson syndrome), toxic epidermal necrolysis (Lyell’s syndrome), allergic myocarditis, hyperemia of the sclera. Symptoms: intestinal colic, headache, depression; For prolonged overdose — thrombocytopenia, leukopenia, megaloblastic anemia. Treatment: gastric lavage, acidification of urine increases the excretion of trimethoprim, fluid intake by mouth, in / m — 5-15 mg / day calcium folinate (eliminates the effect of trimethoprim on the bone marrow), if necessary — hemodialysis.
Dosage and administration:
Inside, in / in / m. In each dosage form, the quantitative ratio of trimethoprim and sulfamethoxazole 1: 5. Orally (tablets), adults and children over 12 years — 960 mg dose or 480 mg 2 times a day. In severe infections — 480 mg 3 times daily, for chronic infections maintenance dose — 480 mg 2 times a day. Children 1-2 years — 120 mg 2 times a day, 2-6 years — 120-240 mg 2 times a day, 6-12 years — 240-480 mg 2 times a day. Suspension: children 3-6 months — 120 mg 2 times a day, 7 months-3 years — 120-240 mg 2 times a day, 4-6 years — 240-480 mg 2 times a day, 7-12 years — 480 mg 2 times a day, adults and children over 12 years — 960 mg 2 times a day. Syrup for children: children 1-2 years — 120 mg 2 times a day, 2-6 years — 180-240 mg 2 times a day, 6-12 years — 240-480 mg 2 times a day. The minimum duration of treatment — 4 days; To maximize the effectiveness of a constant concentration of trimethoprim in plasma or serum should be maintained at 5 mg / ml or higher. To achieve the higher concentrations in the CSF is administered / drip (dissolved in 200 ml solvent) for 1 h, 2 times a day. In renal insufficiency, the dose depends on the amount of QA: QC than 25 ml / min — a standard dose; at 15-25 ml / min — standard dose for 3 days, then half the standard dose. In severe infections in all age groups, the dose may be increased to 50%. Generic BactrimÂ (Trimethoprim And Sulfamethoxazole) you can buy through the Internet, it will cost you cheap.
It is desirable to determine the concentration of sulfamethoxazole in plasma every 2-3 days immediately before the next infusion. If the concentration exceeds sulfamethoxazole 150 mg / ml, treatment should be interrupted as long as it does not fall below 120 mcg / ml. During long-term (more than one month) courses of treatment need regular blood tests because there is the risk of hematological changes. Particular caution should be shown in the treatment of elderly patients or patients with suspected initial lack of folate. During treatment to use foods that contain large amounts of PABA — green parts of plants (cauliflower, spinach, bean), carrots, tomatoes. Avoid excessive solar and UV radiation. The risk of side effects is significantly higher in patients with AIDS. Not recommended for pharyngitis and tonsillitis caused by beta-hemolytic streptococcus group A, because of widespread resistance strains.
Pharmaceutically compatible with the following drugs: dextrose for in / infusion of 5 and 10%, levulose for in / infusion of 5%, NaCl for in / infusion of 0.9%, a mixture of 0.18% NaCl and 4% dextrose in / infusion, 6 70% for the dextran / in infusion or 5% dextrose solution, 0.9% NaCl, 10% dextran 40 in / infusion or 5% dextrose solution, 0.9% NaCl, Ringer’s Injection. Increases the anticoagulant activity of indirect anticoagulants, as well as the action of hypoglycemic drugs and methotrexate. Reduces the intensity of the hepatic metabolism of phenytoin and warfarin, increasing their effect. Reduces the reliability of oral contraceptives (inhibits intestinal microflora and reduces the enterohepatic circulation of hormonal compounds). Ascorbic acid, hexamethylenetetramine (et al. PM, acidifying the urine) increase the risk of crystalluria. Cholestyramine reduces absorption, it should be taken 1 hour after 4-6 hours or until the reception of co-trimoxazole. Drugs suppress bone marrow hemopoiesis, increased the risk myelosuppression.
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