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Brand: Bactrim, Septra, Cotrim, Sulfatrim
Trimethoprim-sulfamethoxazole (TMP-SMX), also known as co-trimoxazole, is a combination antibiotic used to treat a variety of bacterial infections. It consists of two synthetic antibacterial agents: trimethoprim and sulfamethoxazole. TMP-SMX works by inhibiting two sequential steps in bacterial folic acid synthesis, a pathway crucial for bacterial growth and survival. It is particularly effective against gram-negative bacteria and certain gram-positive bacteria. Due to its synergistic effect, TMP-SMX is often more effective than either drug alone.
Used to treat urinary tract infections, ear infections, bronchitis, traveler's diarrhea, and certain types of pneumonia and other infections.
Fatalities associated with Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, other blood dyscrasias. Blood dyscrasias associated with trimethoprim-sulfamethoxazole are usually reversible by folinic acid administration.
Outcome:
Increased bleeding risk
Mechanism:
TMP-SMX inhibits warfarin metabolism.
Outcome:
Increased risk of hyperkalemia
Mechanism:
TMP can increase potassium levels.
Outcome:
Decreased TMP-SMX absorption
Mechanism:
Antacids can reduce the absorption of TMP-SMX.
Most likely new formulation: extended-release formulation for improved patient compliance (Year: 2025, 70% confidence)
Based on current resistance trends, there is a 20% likelihood of increased restrictions on TMP-SMX use for uncomplicated UTIs within the next 5 years.
Antibiotic
Sulfonamide, Diaminopyrimidine