NAME OF DRUG
cotrimoxazole

CLASSIFICATION

Antibacterial

ALTERNATE NAMES

BACTRIM, SEPTRA

 INDICATIONS

• treatment of infections due to susceptible organisms

 RECONSTITUTION AND STABILITY

• dilute each 5 mL ampoule with 125 mL of D5W or NS, the prepared solution must be kept at room temperature (solution stable for 24 hours)
• in fluid restriction:  each 5 mL ampoule may be diluted with 75 mL D5W or NS (solution stable for a total of 3 hours, inluding infusion period)
• each 5 mL ampoule may be diluted with 50mL D5W or NS (solution stable for a total of 1.5 hours, including infusion period)
• discard if there is cloudiness or precipitation

 COMPATIBILITY

• compatible with D5W (preferred), NS, RS
• compatible via Y-site with acyclovir, cyclosporine, hydromorphone, lorazepam, magnesium sulphate, meperidine, morphine, multivitmins, piperacillin-tazobactam, potassium chloride
• incompatible with other drugs

 ROUTES OF ADMINISTRATION

• IV intermittent - over 30-60 minutes

 VH & HSC ADMINISTRATION POLICY

A - Not to be administered by the direct IV route.

 DOSAGE

Cotrimoxazole is a fixed combination product containing sulfamethoxazole and trimethoprim in 5:1 ratio.

Pneumocystis Carinii Pneumonia:

• Adults and children: 5 mg/kg trimethoprim (as cotrimoxazole) every 6 hours

Gram-Negative Sepsis:

• Adults: 2.5 mg/kg trimethoprim (as cotrimoxazole) every 6 hours
• Dosage interval must be lengthened in renal impairment: (2.5-5 mg/kg/dose)

• hypersensitivity reactions
• pain, local irritation, inflammation, and rarely thrombophlebitis

• hematologic toxicity:  neutropenia, thrombocytopenia, agranulocytosis, aplastic anemia
• contraindicated in patients with known hypersensitivity to trimethoprim or sulfonamides, or with documented megaloblastic anemia secondary to folate deficiency
• use with caution in patients with impaired renal or hepatic function or with possible folate or G-6-PD deficiency

Rev. Oct 2004