Cotrimoxazole 800/160 Stella medicine for infections (10 blisters x 10 tablets)

Dosage form Box of 10 blisters x 10 tablets
Specifications Sulfamethoxazole, trimethoprim
Ingredient Middle otitis, plague, prostatitis, urinary tract infections, chronic respiratory infections

Ingredient

Composition information	Content
Sulfamethoxazole	800mg
Trimethoprim	160mg

Uses

indications

Acute otitis media.

Treatment of chronic or recurrent urinary tract infections or prostatitis.

Treatment of respiratory infections.

Treatment of gastrointestinal infections.

Treatment of Brucella.

Treatment of cholera.

Treatment of plague.

Treatment of pneumocystis jiroveci pneumonia (Pneumocystis Carinii).

Treatment of Toxoplasma disease.

Pharmacokology

cotrimoxazole is a mixture of sulfamethoxazole (5 parts) and trimethoprim (1 part). 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.

pharmacokinetics

absorption:

cotrimoxazole absorbs well and quickly through the gastrointestinal tract. After taking a single dose of cotrimoxazole, including 160 mg of trimethoprim and 800 mg of sulfamethoxazole, the peak concentration reached after 1-4 hours in the serum of Trimethoprim is 1 - 2 mcg/ml and sulfamethoxazole without cohesion of 40 - 60 mcg/ml.

Distribution:

cotrimoxazole widely distributed in tissue and muscle 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.

Era:

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 800/160 Stella medicine for infections (10 blisters x 10 tablets)

How to use

cotrimoxazole 800/160 is taken with food or drink to minimize the possibility of digestive disorders.

Dosage

Cotrimoxazole dose is calculated in trimethoprim in fixed combination containing sulfamethoxazole 5 mg and trimethoprim 1 mg.

Acute otitis media:

Children 2 months and older: The usual dose of cotrimoxazole is 8 mg trimethoprim (in cotrimoxazole)/kg/day divided into 2 small doses separated by 12 hours. Time of treatment is usually 10 days.

Chronic or recurrent urinary tract infections or prostatitis:

Adults: 160 mg trimethoprim (in cotrimoxazole) tablets every 12 hours for 10-14 days for chronic or recurrent urinary tract infections or for 3-6 months for prostatitis.

Prevention of chronic infections or urinary recurrence:

Adults: dose 40 - 80 ng trimethoprim (in cotrimoxazole)/day or 3 times/week for 3-6 months.

Children from 2 months of age: Normal dose 8 mg trimethoprim (in cotrimoxazole)/kg/day divided into 2 small doses 12 hours/time.

Respiratory infections:

Adults: The usual dose of 160 mg trimethoprim (in cotrimoxazole)/ time 12 hours apart, 14 days.

Gastrointestinal infections:

dysentery bacillus (S. Flexneri or S.Sonnei):

Adults: The usual dose of 160 mg trimethoprim (in cotrimoxazole)/time 12 hours apart.

Children: Trimethoprim oral dose (in cotrimoxazole) is 10 mg/kg/day (maximum 480 mg/day) divided into 2 small doses for 4-6 weeks.

Cholera:

Adults: The dose of 160 mg trimethoprim (in cotrimoxazole tablets) taken twice a day, taken for 3 days.

Children: Trimethoprim dose 4 - 5 mg/kg (in cotrimoxazole tablets) 2 times a day, taken for 3 days, combined with infusion and electrolytes.

Plague:

Preventive for people who contact people with pulmonary plague:

Adults: Trimethoprim 320 - 640 mg/day (in cotrimoxazole) is divided into 2 small doses of drink 12 hours apart, drink for 7 days.

Children at least 2 months of age and older: oral dose of trimethoprim 8 mg (in cotrimoxazole)/kg/day divided into 2 small doses, drink for 7 days.

Adults and children over 2 months of age: Trimethoprim's usual oral dose (in cotrimoxazole) is 15-20 mg/kg/day divided into 3 or 4 small doses equal. The usual treatment time is 14 - 21 days.

Priority or secondary backup:

In adults and teenagers infected with HIV: trimethoprim oral dose (in cotritmoxazole) is 160 mg x 1 time/day.

Other ways are also recommended: trimethoprim oral dose (in cotrimoxazole) is 80 mg x 1 time/day.

Priority or secondary backup in children, including HIV -infected children: Trimethoprim dosage disruptive regimen (in cotrimoxazole) is 150 mg/m2 divided into 2 small doses, drink for 3 days per week.

Toxoplasma disease:

Primary prophylaxis in adults and teenagers: The oral dosage of trimethoprim (in cotrimoxazole) is 160 mg x 1 time/day or 80 mg x 1 time/day.

Primary prophylaxis in children with HIV infected: Trimethoprim doses (in cotrimoxazole) are 150 mg/m2/day divided into 2 small doses.

Patients with renal failure:

When the kidney function decreases, the dose is reduced according to the following table:

Creatinine clearance (ml/minute) recommended dose 30 Use Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose?

Symptoms:

Nausea, vomiting, diarrhea, dementia, confusion, face swelling, headache, bone marrow failure and slight increase in serum aminotransferase (transaminase).

Management:

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

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, lupus erythematosus, especially worsening the available diseases.

Kidney: Interstitial nephritis and kidney necrosis, Lumbar pain, bleeding, little urination and difficulty urinating.

Blood disorders: granulocytes, property anemia, thrombocytopenia, leukopenia, prothrombin and eosinophilic hypercasses like eOSIN.

Disorders of liver and jaundice.

Uncommon, 1/1000

No report.

Rare, 1/10000

Blood disorders: 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 failure when the kidney function cannot be controlled or when the clearance is less than 15 ml/min.

Patients with large red blood cells due to folat deficiency.

Pregnant and lactating women.

Children under 2 months of age.

Be cautious when using

sore throat due to S. Pyogenes: Do not use cotrimoxazole.

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 effect 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 treatment benefits are higher than the risk of harm to the fetus. Because sulfonamid can cause jaundice in newborns, 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.

Interactive drug

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 poison but can recover in patients with kidney implants using cotrimoxazole along with cyclosporin.

Digoxin: Increasing serum Digoxin levels can occur in patients using cotrimoxazole; This interaction often happens in the elderly.

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

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

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

Amantadin: Poisoned 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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