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 Zambia HIV National Guidelines
 


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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Trimethoprim

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
10-15-2010

Zambia Specific Information

  • 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.

INDICATIONS

FDA

  • Urinary tract infections (uncomplicated) caused by E. coli, P. mirabilis, K. pneumoniae, Enterobacter species, and S. saprophyticus
NON-FDA APPROVED USES

  • Pneumocystis jiroveci pneumonia (in combination with dapsone)
  • Campylobacter jejuni 

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
ProloprimTrimethoprim~Various generic manufacturersPO
tab
100mg
$0.68
PrimsolTrimethoprimFSC Laboratories PO
sol
50mg/5mL (473mL)
$186.12

*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.

USUAL ADULT DOSING

  • 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

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

UTI: 100mg q24h. PCP: 5mg/kg q8-12h.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Manufacturer recommends avoiding, but for PCP: 5-7.5mg/kg/day (1/2-1/3 standard dose) in combination with dapsone.

DOSING IN HEMODIALYSIS

PCP: 5-7.5 mg/kg/d. On days of HD, dose 5 mg/kg post dialysis in combination with dapsone.

DOSING IN PERITONEAL DIALYSIS

PD does not efficiently remove TMP. UTI: 100-200 mg q48h. PCP: no data, consider 5-7.5 mg/kg/d.

DOSING IN HEMOFILTRATION

No data. See TMP/SMX.

ADVERSE DRUG REACTIONS

COMMON

  • GI upset (dose related)
OCCASIONAL

  • Megaloblastic anemia
  • Neutropenia
  • Thrombocytopenia
  • Reversible hyperkalemia (with high dose trimethoprim)
  • Liver enzyme elevation
  • Pancytopenia
  • Rash and pruritis
RARE

  • Erythema multiforme, Stevens-Johnson syndrome and TEN (unclear association)

DRUG INTERACTIONS

  • 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.

SPECTRUM

E. coli , P. mirabilis, K. pneumoniae, Enterobacter species, and S. saprophyticus

PHARMACOLOGY

Pharmacology

COMMENTS

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.

REFERENCES

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