Cotrimoxazole 400/80 Stella medicine for infections (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Sulfametoxazol, trimethoprim
Ingredient Urinary tract infections, skin and soft tissue infections, acute bronchitis, upper respiratory tract infections, chronic bronchitis

Ingredient

Composition information	Content
Sulfametoxazol	400mg
Trimethoprim	80mg

Uses

Indications

Cotrimoxazole 400/80 pills are indicated in the following cases:

Acute otitis media treatment. Treatment of pneumonia caused by Pneumocystis Jiroveci (Pneumocystis Carinii).

Treatment of Toxoplasma. Sulfamethoxazole is a sulfonamid, inhibiting the competition of bacterial folic acid synthesis. Trimethoprim is a derivative of pyrimidine, inhibiting the enzyme specific to the bacterium of bacteria. Combining trimethoprim and sulfamethoxazole so inhibited two consecutive stages of folic acid metabolism, thus effectively inhibits the synthesis of purin, thymidin and the last DNA of bacteria. This serial inhibition has bactericidal effects. This co -mechanism also resists the growth of anti -drug bacteria and makes the drug work even when bacteria resist each ingredient of the drug.

The following microorganisms are often sensitive to drugs: E. Coli, Klebsiella spp. Shigella Sonnei, Pneumocystis Carinii.

cotrimoxazole has some effects on Plasmodium falciparum and toxoplasma gondii.

The anti -drug microorganisms are: Enterococcus, Pseudomonas, Campylobacter, Anaerobes (anaerobes), Meningococcus, Gonococcus (Gonococcus), Mycoplasma.

resistant to cotrimoxazole slowly developed in vitro compared to each single ingredient of the drug. This resistance increases in both gram -positive and gram -negative bacteria. Significant resistance in Entobacter.

In Vietnam, according to the report of the National Monitoring Program on drug resistance of pathogenic bacteria (ASTS), the resistance of cotrimoxazole grows very fast, many bacteria in the 70s and 80s of the 20th century are often sensitive to cotrimoxazole, now strong resistance (Haemophilus infuenzae, e.coli, klebsiella, protous spp, enterobacter. Salmonella Typhi ...).

Cotrimoxazole resistance of bacteria varies from each region (North, Central, South), rural or urban areas, so when treatment should choose appropriate drugs.

pharmacokinetic

absorption

cotrimoxazole absorbs well and quickly through the gastrointestinal tract.

Distribution

cotrimoxazole is widely distributed in tissue and body fluid including saliva, aquatic fluid, middle ear fluid, prostate fluid, vaginal fluid, bile and cerebrospinal fluid; Trimethoprim is also distributed in lung secretion. The distribution volume of trimethoprim is higher than sulfamethoxazole. Trimethoprim binds with plasma proteins about 44% and sulfamethoxazole bond about 70%. Cotrimoxazole is easy through placenta and distributed into breast milk.

Metabolism

cotrimoxazole is metabolized through the liver. Trimethoprim's waste time is about 8 - 11 hours and sulfamethoxazole 10 - 13 hours in adults with normal kidney function.

Elimination

about 50 - 60% trimethoprim and 45 - 70% sulfamethoxazole oral dose is excreted through urine within 24 hours. About 80% trimethoprim and 20% sulfamethoxazole are found in urine in constant form. Only a small amount of trimethoprim is eliminated by stool due to secretion in the bile.

Before taking Cotrimoxazole 400/80 Stella medicine for infections (10 blisters x 10 tablets)

How to use

cotrimoxazole 400/80 is taken with food or drink to minimize the possibility of digestive disorders.

Dosage

dose of cotrimoxazole according to weight is calculated in trimethoprim in fixed combination containing sulfamethoxazole 5mg and trimethoprim 1mg.

Ear otitis media in children from 2 months of age

trimethoprim 8mg/kg/day, divided 2 times, for 10 days.

Chronic or recurrent urinary tract infections or prostatitis

Adults: 2 capsules x 2 times/day x 10 - 14 days (chronic or recurrent urinary tract infections) or x 3-6 months (prostatitis).

Prevention of chronic infection or urinary tract relapse

Adults: ½ - 1 tablet, daily or 3 times/week, for 3-6 months.

Children ≥ 2 months of age: 8mg/kg/day divided 2 times.

Respiratory infections

Adults: 2 capsules x 2 times/day x 14 days.

Bacterial gastrointestinal infections

Adults: 2 capsules x 2 times/day.

Children: 8mg/kg/day divided 2 times, in 5 days.

Brucella disease

Children: 10mg/kg/day (maximum 480mg/day) divided 2 doses, for 4-6 weeks.

Cholera

Adults: 2 capsules x 2 times/day, for 3 days.

Children: 4 - 5mg/kg x 2 times/day, for 3 days, in combination with infusion and electrolytes.

Plague

Backup - Adults: 4 - 8 capsules/day divided 2 times, in 7 days.

Children over 2 months of age: 8mg/kg/day divided 2 times, in 7 days.

pneumocystis jiroveci (PCP)

Adults and children over 2 months old: 15 - 20mg/kg/day, divided 3-4 times, in 14 - 21 days.

Primary or secondary reserve: Adults and teenagers: 1-2 capsules/1 time/day; Children, including HIV -infected children: 150mg/m2 divided 2 times, taken for 3 days per week.

Toxoplasma disease

Primary Prevention in adults and teenagers: 1-2 capsules/1 time/day. Primary provision for children infected with HIV: 150mg/m2/day, divided 2 times.

Renal failure: CLCR

What to do when overdose?

Treatment: In the case of cotrimoxazole poisoning, the stomach should be empty by causing vomiting or gastric lavage. Conduct supportive treatment and symptomatic treatment. Patients should be monitored with blood formula and other appropriate clinical tests (such as the concentration of electrolytes in serum). Hemolysis can only eliminate a moderate amount of drugs; The abdominal appraisal does not increase the efficiency of elimination of cotrimoxazole.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using cotrimoxazole 400/80, you may experience unwanted effects (ADR).

Common, ADR> 1/100:

Digestive: Nausea, vomiting, anorexia and diarrhea.

Hypersensitivity: Fever, skin reactions include rash, itching, light sensitivity, flaking dermatitis and rash. The possibility of death, skin reactions including epidermal necrosis, Stevens-Johnson syndrome.

Other: Dermatitis, all -body lupus, especially worsening the available diseases. kidney: interstitial nephritis and kidney necrosis, Lumbar pain, bleeding, little and difficult urination. Hematology: granulocytosis, property anemia, thrombocytopenia, leukopenia, prothrombin and eosinophilia prefer EOSIN. liver: liver enzyme disorders and jaundice.

Rare, 1/10000

Hematology: Methemoglobin, acute hemolytic anemia.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Contraindicated

Patients with hypersensitivity to sulfamethoxazole or trimethoprim or any ingredient of the drug.

Patients with severe liver damage.

Patients with severe renal impairment when the kidney function cannot be controlled or when the clearance is less than 15ml/min.

Patients with large red blood cells due to folat deficiency.

Pregnant and lactating women.

Children under 2 months of age.

Caution when using

S. Pyogenes: Cotrimoxazole should not be used.

Cotrimoxazole should be used with patients with renal impairment, patients are likely to lack folat (such as the elderly, alcoholic, people who are taking anti-convulsions, malnutrition people, people with malabsorption syndrome), patients with severe allergies or asthma, or with patients with glucose-6-phosphate dehydrogenase (G-6-PD).

Patients who are taking cotrimoxazole should pay attention to maintain adequate drinking to avoid crystallizing urine and urolhyte formation.

Should regularly conduct blood formula tests, urine analysis, renal function for patients being treated for a long time with cotrimoxazole.

Elderly people may be highly sensitive to unwanted effects of the drug.

The ability to drive and operate machinery

There has been no research on the influence of the drug on the ability to drive and operate machinery. However, it is important to note the clinical manifestations of the patient and the unwanted effects of the drug on the ability to operate machinery.

Pregnancy

cotrimoxazole through the placenta and may affect the metabolism of folic acid, so the drug is only used during pregnancy when the benefits of treatment are higher than the risk of harm to the fetus. Because sulfonamid can cause jaundice in infants, cotrimoxazole is contraindicated for pregnant women.

breastfeeding period

cotrimoxazole distributed into breast milk. Because sulfonamid can cause jaundice in children under 2 months of age, the decision to stop breastfeeding or stop taking cotrimoxazole or use other drugs instead, consider the importance of cotrimoxazole for the mother.

Medicinal interaction

Interaction of drugs

warfarin

Cotrimoxazole can extend the blood clotting time of patients taking warfarin due to the inhibitor of the metabolic clearance of warfarin.

phenytoin

cotrimoxazole inhibits the metabolism of phenytoin.

methotrexate

Because sulfonamid can occupy methotrexate in cohesion with plasma proteins thus increases the concentration of free methotrexate.

cyclosporin

Signs of kidney poisoning but can recover in patients with kidney implants using cotrimoxazole along with cyclosporin.

digoxin

Increased serum Digoxin levels may occur in patients using cotrimoxazole; This interaction often happens in the elderly.

indomethacin

Increased sulfamethoxazole concentration in plasma can occur when patients are using indomethacin.

pyrimethamine

Large red blood cell anemia has been reported in patients taking cotrimoxazole and pyrimethamine more than 25mg/week (to prevent malaria).

Antidepressants: Cotrimoxazole can reduce the effectiveness of 3 -round antidepressants.

Amantadin

Poisonous delirium has been reported when used in combination with cotrimoxazole with amantadin.

Storage

Store in closed packaging, dry place. The temperature does not exceed 30 ° C.

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