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Administration

Sulfamethoxazole/trimethoprim may be administered orally without regard to meals. However, taking it with at least 8 ounces of water is best. It also has an intravenous formulation. The choice of oral or intravenously varies depending on the type of infection/or type of prophylactic use. It should not be administered intramuscularly. Patients with impaired renal function must have calculated dosing regimens based on renal function, as listed below. Administration of the 2 drugs is in a 1 to 5 ratio (trimethoprim:sulfamethoxazole) as a tablet formulation; this is so when they enter the body, their concentration throughout the blood/tissues is 1 to 20, which is the peak synergistic desired effect ratio of the 2 drugs in combination.[6]

Bacterial Infections

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Oral dosage in adults and children weighing 40 kg (88 pounds) or more should have a single tablet of 800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 10 to 14 days. Children 2 months and older must have a weight-adjusted dosage.

Treatment of Pneumocystis jirovecii Pneumonia/Pneumocystis carinii Pneumonia

Adults/children, 2 months and older: The dose is also weight-adjusted. Usually, 75 to 100 mg per kilogram of body weight for sulfamethoxazole and 15 to 20 mg per kilogram for trimethoprim daily for 14 to 21 days.[6]

Prevention of Pneumocystis jirovecii pneumonia/ pneumocystis carinii pneumonia

In adults, 800 mg of sulfamethoxazole and 160 mg of trimethoprim are given daily. In children 2 months of age and older, dosages are determined by body size.[6]

Traveler’s Diarrhea

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In adults, 800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 5 days. For children 2 months and older, use and dosage vary.

Chronic Bronchitis

For acute exacerbations due to strains of Streptococcus pneumoniae or Haemophilus influenzae, 1 tablet of 800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 10 to 14 days.[7]

Shigellosis

Enteritis caused by Shigella flexneri and Shigella sonnei: 1 tablet 800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 5 days; antimicrobial resistance is an increasing concern in this infection.[8]

Urinary Tract Infections

Pyelonephritis

One tablet of 800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 14 days

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Prostatitis

One tablet of 800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 14 days or 2 to 3 months if a chronic infection.[9]

Acne Vulgaris (Non-FDA Approved)

One tablet of 800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 18 days

Community-Acquired Pneumonia (Non-FDA Approved)

One tablet of 800 mg of sulfamethoxazole and 160 mg of trimethoprim every 12 hours for 10 to 14 days

Renal impairment guidelines are as follows:

Use is not recommended in children younger than 2 months of age.

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