Paul A. Pham Pharm.D. and John G. Bartlett M.D.
Available formulation in Zambia: Tablet: 100 mg; 200 mg.
- May be used for acute uncomplicated urinary tract infections (UTI) caused by susceptible organisms and prophylaxis of UTIs.
- UTI, uncomplicated: 100 mg PO twice a day or 200 mg PO once a day for 10 days.
- PCP treatment (mild to moderately severe): dapsone 100 mg every day + TMP 5mg/kg q8h.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Urinary tract infections (uncomplicated) caused by E. coli, P. mirabilis, K. pneumoniae, Enterobacter species, and S. saprophyticus
Pneumocystis jiroveci pneumonia (in combination with dapsone)
|Proloprim||Trimethoprim||~Various generic manufacturers||PO|
|Primsol||Trimethoprim||FSC Laboratories ||PO|
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- Uncomplicated UTI: 200 mg PO daily in 1-2 doses (note: TMP/SMX preferred for this indication, but TMP alone used if sulfa intolerant)
- Mild-moderate PCP: TMP 5mg/kg PO q8h + dapsone 100mg PO once daily
UTI: 100mg q24h. PCP: 5mg/kg q8-12h.
Manufacturer recommends avoiding, but for PCP: 5-7.5mg/kg/day (1/2-1/3 standard dose) in combination with dapsone.
PCP: 5-7.5 mg/kg/d. On days of HD, dose 5 mg/kg post dialysis in combination with dapsone.
PD does not efficiently remove TMP. UTI: 100-200 mg q48h. PCP: no data, consider 5-7.5 mg/kg/d.
No data. See TMP/SMX.
- Megaloblastic anemia
- Reversible hyperkalemia (with high dose trimethoprim)
- Liver enzyme elevation
- Rash and pruritis
- Erythema multiforme, Stevens-Johnson syndrome and TEN (unclear association)
E. coli , P. mirabilis, K. pneumoniae, Enterobacter species, and S. saprophyticus
- Dapsone: increased serum level of both dapsone (40%)and trimethoprim (48%).This interaction may be beneficial in the treatment of . No dose adjustment needed.
- Methotrexate: plasma concentration of methotrexate may be increased due to decreased renal clearance. Monitor for pancytopenia with co-administration. Dose of methotrexate may need to be decreased.
- Phenytoin: phenytoin concentration may be increased due to trimethoprim Inhibition of hepatic metabolism. Management recommendation: monitor for phenytoin toxicity (drowsiness, nystagmus, dysarthria and tremor) and serum levels. Dose may need to be adjusted.
- Procainamide: elevated procainamide and N-acetylprocainamide (NAPA) serum level secondary to competitive inhibition of renal tubular secretion between trimethoprim and procainamide. Monitor serum level of procainamide and N-acetylprocainamide in addition to monitoring EKG for QTc prolongation and arrythmia.
Generally used in combination with sulfamethoxazole. Only acceptable indication for monotherapy is acute uncomplicated UTI. TMP/dapsone is an alternative to TMP/SMX in the treatment of mild to moderately severe PCP, but should not be used with severe disease.