What does Cotrim 960 do?

Cotrim 960 is a combination antibiotic between Sulfamethoxazole and Trimethoprim. The drug has a broad antibacterial spectrum, so it is widely used in the treatment of various inflammatory diseases in the gastrointestinal tract, respiratory tract, urinary tract,... Let's learn about the uses and notes when using the drug. Cotrim 960 through the article below.

The drug Cotrim 960 contains the main active ingredients are Sulfamethoxazole and Trimethoprim with the ratio 800mg/160mg. The drug is indicated in the treatment of the following conditions:
Urinary tract infections including: Prostatitis, acute uncomplicated urinary tract infections, recurrent or chronic urinary tract infections; Acute respiratory tract infections: The drug is used in the treatment of acute attacks of chronic bronchitis; Gastrointestinal infections: Traveler's diarrhea, Shigella infection; Acute otitis media ; Treatment of cholera in patients contraindicated to tetracycline or infection with Vibrio Cholerae bacteria resistant to tetracycline antibiotics; Treatment of pneumonia caused by Pneumocystis jiroveci; Prevention of diseases caused by Toxoplasma bacteria and treatment of diseases caused by bacteria Nocardia.

The combination of two antibiotics Sulfamethoxazole and Trimethoprim in a ratio of 5:1 provides a broad antibacterial effect. The drug works by inhibiting the enzymes of folic acid metabolism. Among them, Sulfamethoxazole acts by inhibiting the formation of tetrahydrofolic acid from dihydrofolic acid through inhibition of dihydrofolate reductase. By inhibiting the synthesis of tetrahydrofolic acid - the active metabolite of folic acid, the drug inhibits the synthesis of thymidine in bacteria.

The drug is rapidly and well absorbed from the gastrointestinal tract. Following oral administration of a single dose of 800 mg of Sulfamethoxazole and 160 mg of Trimethoprim, peak serum concentrations are reached approximately 1 to 4 hours later. In which, the peak concentration of Sulfamethoxazole is 40 - 60 mcg/ml and about 1-2 mcg/ml for Trimethoprim. Co-trimoxazole is widely distributed into tissues and body fluids including aqueous humor, saliva, prostate fluid, middle ear fluid, bile into cerebrospinal fluid, vaginal fluid, pulmonary secretions. The volume of distribution (Vd) of Trimethoprim is higher than that of Sulfamethoxazole. The plasma protein binding of Sulfamethoxazole is about 70% and about 44% for Trimethoprim. The drug easily crosses the placenta and is distributed into breast milk. The metabolism of Co - trimoxazole occurs in the liver. The half-life (t1/2) ranges from 8 to 11 hours for trimethoprim and 10 to 13 hours for sulfamethoxazole in adults with normal renal function. Approximately 50 to 60% of a trimethoprim dose and 45 to 79% of a sulfamethoxazole dose are excreted in the urine within 24 hours.

Cotrim 960 should be taken with meals to help reduce the possibility of digestive disorders. Dosage depends on the patient and disease condition, specifically as follows:
Adults:
Urinary tract infections: Acute uncomplicated urinary tract infections: Take 1 tablet every 12 hours for 10 hours. or take a single dose of 2 tablets/time for 3-7 days; Chronic or recurrent urinary tract infections: Take 1 tablet every 12 hours for 10-14 days; Prostatitis: Take 1 tablet every 12 hours for 3-6 months. Respiratory tract infections: Treatment of acute exacerbations of chronic bronchitis caused by susceptible strains of bacteria such as Haemophilus influenzae or Streptococcus pneumoniae: Take 1 tablet every 12 hours for 10-14 days; Gastrointestinal infections: Shigella infection caused by S.sonnei or S.flexneri: Take 1 tablet/time every 12 hours for 3-5 days; Traveler's diarrhea caused by toxins of E.coli: Take 1 tablet every 12 hours for 3-5 days; Acute otitis media: Take 1 capsule/time every 12 hours for 10 days; Cholera: Take 1 tablet/time x 2 times/day for 3 days. Combined with rehydration and electrolytes. Pneumocystis carinii pneumonia (PCP): Treatment: Oral 120mg/kg/day (100mg Sulfamethoxazol, 20mg Trimethoprim) divided into 2-4 times, maintained for 14-21 days; Prevention of secondary and primary Pneumocystis carinii pneumonia in HIV-infected adults and adolescents: Take 1 tablet once a day for 3 consecutive days. Treatment of diseases caused by Nocardia and prevention of diseases caused by Toxoplasma: Take 1 tablet/day for 14-21 days.

Children:
Use a dose of 40mg Sulfamethoxazol/kg, 8mg Trimethoprim in 2 divided doses every 12 hours.
Patients with renal failure:
Dosage depends on creatinine clearance (CC) as follows:
CC > 30ml/min: Use the usual indicated dose; CC range from 15 to 30mg: Use 1/2 of the usual indicated dose; CC < 15ml/min: Not indicated for use.

Some side effects that may be encountered when using Cotrim 960 are as follows:
Common side effects: Anorexia, vomiting, nausea and diarrhea. Hypersensitivity reactions: Common: Skin reactions such as pruritus, rash, photosensitivity, erythema, exfoliative dermatitis, fever; Serious: Skin reactions such as epidermal necrolysis, Stevens-Johnson syndrome; Other reactions: Systemic lupus erythematosus, dermatitis, especially drugs can aggravate existing diseases. Nephrotoxicity: Tubular necrosis, interstitial nephritis, hematuria, low back pain, oliguria and dysuria are unlikely. Blood disorders: Aplastic anemia, agranulocytosis, agranulocytosis, thrombocytopenia, decreased prothrombin, eosinophilia. Cholestatic jaundice, liver enzyme disorders: Acute hemolytic anemia, cyanosis due to methemoglobin but low rate.

Cotrim 960 is contraindicated in the following cases:
Patients with hypersensitivity to Trimethoprim, Sulfamethoxazol or any of its ingredients; Patients with severe liver damage; Patients with severe renal failure when renal function cannot be controlled or when creatinine clearance < 15ml/min; Patients with red blood cell anemia (folate deficiency); Pregnant women, lactating women; Children under 2 months old.

Use caution when using the drug in patients with renal failure, patients at risk of folate deficiency (such as alcoholics, elderly people, people being treated with anticonvulsants, malnourished patients, patients with poor syndromes). absorption), patients with bronchial asthma, severe allergies or glucose - 6 - phosphate dehydrogenase (G - 6 - PD) deficiency.
Patients being treated with Co-trimoxazole should be careful to drink enough water to avoid the risk of urine crystallization and kidney stone formation. Besides, it is necessary to regularly check blood count, evaluate kidney function, analyze urine when taking drugs for a long time.
Caution when using the drug in the elderly due to high sensitivity to the side effects of the drug.

Pregnancy: Co-trimoxazole crosses the placental barrier and may interfere with folic acid metabolism. Therefore, the use of the drug is contraindicated in pregnant women.
Lactating women: The drug is distributed into breast milk. Therefore, breast-feeding should be discontinued when taking Co-trimoxazole or stopping use of Co-trimoxazole while breastfeeding.
Drivers, operating machines: Co-trimoxazole can cause dizziness, tinnitus, drowsiness, insomnia and hallucinations. Patients need to make sure they are not affected by the drug before driving or operating machinery.

Warfarin: Concomitant use of Co-trimoxazole prolongs the blood clotting time of patients being treated with Warfarin, because the drug inhibits the clearance of Warfarin's metabolite. Phenytoin: Cotrim 960 inhibits the metabolism of Phenytoin. Methotrexate: Sulfonamides compete with methotrexate for plasma protein binding, so the drug may increase the free concentration of methotrexate. Cyclosporin: Concomitant use with Cotrim 960 may cause nephrotoxicity. Digoxin: Digoxin serum concentrations are increased when co-administered with Cotrim 960 (this interaction is more likely to occur in the elderly). Indomethacin: Increased plasma concentrations of Indomethacin may occur when co-administered with Cotrim. Pyrimethamine: Macrocytic anemia has been reported in patients treated with Co-trimoxazole and pyrimethamine at doses exceeding 25 mg/week. Antidepressants: The effectiveness of the drug may be reduced when co-administered with Cotrim 960. Amantadine: Concomitant use with Co-trimoxazole has been reported to cause delirium toxicity.