Cotrimoxazole is a combination of two antibiotics: sulfamethoxazole and trimethoprim. Previously, Cotrimoxazole 800mg/160mg was widely prescribed for a range of infections in adults, but its use is now more limited due to its association with some serious side effects. Nevertheless, Cotrimoxazole remains valuable and is often used to treat serious infections.
1. What is Cotrimoxazole used for?
Cotrimoxazole 800mg/160mg tablets are a combination of two different antibiotics called sulfamethoxazole and trimethoprim, used to treat bacterial infections. Like all antibiotics, Cotrimoxazole 800mg/160mg only works against certain types of bacteria.
Accordingly, Cotrimoxazole is suitable for treating or preventing certain types of infections in the following situations:
- Pneumocystis jirovecii pneumonia (PCP), an opportunistic infection
- Infections caused by Toxoplasma bacteria (toxoplasmosis)
- Genitourinary infections
- Respiratory infections
- Ear infections such as otitis media
2. Things to know before taking Cotrimoxazole
Patients should not take Cotrimoxazole if:
- They are allergic to sulfamethoxazole, trimethoprim, co-trimoxazole, or any of the other ingredients in the medicine.
- They are allergic to medicines containing sulphonamide structures, for example, sulfonylureas or thiazide diuretics.
- They have impaired liver or kidney function.
- They have blood disorders causing bruising or bleeding due to low platelets.
- They have been diagnosed with a porphyria metabolic disorder, which can affect the skin or nervous system.
- Cotrimoxazole should not be given to infants in the first 6 weeks of life.
Patients should talk to their doctor or pharmacist before taking Cotrimoxazole if:
- They have severe allergies or asthma.
- Life-threatening skin rashes (Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia, and systemic symptoms have been reported with the use of Cotrimoxazole.
- When starting treatment with Cotrimoxazole, the appearance of generalized skin redness accompanied by pustules and fever should raise suspicion of a severe reaction known as acute generalized exanthematous pustulosis.
- Other signs include sores in the mouth, throat, nose, genitals, and conjunctivitis (red and swollen eyes).
- These potentially life-threatening skin rashes are often accompanied by flu-like symptoms. The rash may progress to widespread blistering or peeling of the skin.
- The highest risk of serious skin reactions is within the first few weeks of taking the medicine. Therefore, if a patient has ever had Stevens-Johnson syndrome, toxic epidermal necrolysis, or drug reaction with eosinophilia and systemic symptoms (DRESS), they should never take Cotrimoxazole again.
3. How to use Cotrimoxazole?
Always take Cotrimoxazole exactly as your doctor has prescribed.
The recommended standard dose for acute infections is:
- Adults (> 18 years): 1 tablet of Cotrimoxazole 800mg/160mg every 12 hours.
- Children over 12 years (> 12 to <18 years): The standard dose for children is equivalent to approximately 6 mg of trimethoprim and 30 mg of sulfamethoxazole per kg of body weight per day, divided into two doses.
- The duration of Cotrimoxazole treatment should be continuous for at least five days.
- If you accidentally take too much Cotrimoxazole 800mg/160mg, you may feel drowsy, dizzy, or tired.
- If you forget to take a dose of Cotrimoxazole, take it as soon as you remember. Do not take a double dose to make up for a missed dose.
4. Possible side effects of Cotrimoxazole
Like all medicines, Cotrimoxazole can cause side effects, although not everyone gets them. Stop taking Cotrimoxazole and tell your doctor immediately if you have an allergic reaction with signs such as difficulty breathing; fainting; swelling of the face, mouth, tongue, or; throat, which may be red and painful, and/or difficulty swallowing; chest tightness; red patches on the skin.
In addition, Cotrimoxazole can also cause the following side effects:
- Increased potassium levels in the blood, can lead to heart rhythm problems.
- Fungal infections called oral thrush or candidiasis, which can affect the mouth or vagina in women.
- Headache.
- Nausea.
- Diarrhea.
- Dermatitis.
- Fever
- Potentially life-threatening skin rashes (Stevens-Johnson syndrome, toxic epidermal necrolysis)
In summary, Cotrimoxazole is a combination antibiotic used to treat bacterial infections such as bladder infections, skin infections, or respiratory infections. Cotrimoxazole works by killing or stopping the growth of the infectious agents. Because it is not effective against viral infections, it is important to understand what Cotrimoxazole is used for and how to use it properly to effectively control infections, avoid side effects, and minimize the risk of antibiotic resistance.
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References: medicines.org.uk, patient.info/, healthnavigator.org.nz, ncbi.nlm.nih.gov
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