Bactrim (Sulfamethoxazole + Trimethoprim) – Broad-Spectrum Antibiotic for Bacterial Infections | EZ Chemist
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What is Bactrim used to treat?
Bactrim is a combination antibiotic containing sulfamethoxazole and trimethoprim. It is used to treat urinary tract infections (UTIs), bronchitis, pneumocystis pneumonia, and various bacterial skin and gastrointestinal infections. It works by inhibiting bacterial folic acid synthesis.

Brand Name: Bactrim

Generic Name: Sulfamethoxazole + Trimethoprim

Formulation: Tablets, Suspensions, Injections

Strength: Bactrim DS (800 mg SMX + 160 mg TMP)

Type: Prescription-only medicine

Drug Class: Sulfonamide and dihydrofolate reductase inhibitor

Availability: Oral (DS tablet), Pediatric suspension, and IV injection

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Sulfamethoxazole (SMX) 800 mg – a sulfonamide antibiotic

Trimethoprim (TMP) 160 mg – a dihydrofolate reductase inhibitor

This fixed-dose combination exhibits synergistic antimicrobial activity.
Co-trimoxazole

TMP-SMX

Bactrim DS / Bactrim SS

Septra

Sulfamethoxazole and Trimethoprim Tablets

Generic Bactrim
Sulfamethoxazole inhibits dihydropteroate synthase, blocking bacterial folate synthesis

Trimethoprim inhibits dihydrofolate reductase, preventing tetrahydrofolic acid formation

The combination leads to sequential blockade of bacterial DNA synthesis, resulting in bactericidal action
Bactrim is indicated for the treatment of:

Urinary Tract Infections (UTIs)

Acute exacerbation of chronic bronchitis

Shigellosis (Shigella enteritis)

Traveler’s diarrhea (due to E. coli)

Pneumocystis jirovecii pneumonia (PCP)

Nocardiosis

MRSA (off-label for mild cases)

Otitis media in children
Indication Typical Adult Dose
UTIs, Bronchitis, Shigellosis 1 Bactrim DS tablet every 12 hours for 10–14 days
Pneumocystis pneumonia (PCP) 15–20 mg/kg/day of TMP in divided doses
Prophylaxis (PCP) 1 DS tablet daily or thrice weekly

Pediatric Dosage: Based on body weight (6–12 mg/kg/day of TMP)

Administration Notes:

Take with a full glass of water

Can be taken with or without food

Adjust dosage in renal impairment

Prescribing Information
Prescription-only (Rx)

Dose must be adjusted in renal dysfunction (monitor creatinine clearance)

Avoid in infants <2 months, pregnancy (especially 1st trimester and near term), and G6PD-deficient patients
Nausea, vomiting

Rash

Loss of appetite

Headache

Serious Side Effects:
Stevens-Johnson Syndrome (SJS)

Blood disorders (e.g., agranulocytosis, thrombocytopenia)

Hepatitis or elevated liver enzymes

Hyperkalemia

Crystalluria and nephrotoxicity in volume-depleted patients
Contraindicated in sulfa allergy

Monitor for rash, sore throat, or fever – could indicate blood dyscrasias

Caution in elderly and HIV patients (higher risk of severe skin reactions)

Use caution with ACE inhibitors, ARBs, and potassium-sparing diuretics due to risk of hyperkalemia

Avoid prolonged sunlight exposure (photosensitivity)

ATC Code: J01EE01

Therapeutic Class: Antibacterial sulfonamides

Regulatory Schedule: Schedule H (Prescription only – India)
Interacting Drug/Class Interaction Notes
Warfarin Increased INR, bleeding risk – monitor PT/INR
ACE inhibitors / ARBs Risk of hyperkalemia
Methotrexate Enhanced bone marrow suppression
Phenytoin Increased phenytoin levels
Cyclosporine Increased nephrotoxicity post-transplant
NEJM Study (1992): TMP-SMX reduced PCP-related mortality by over 50% in HIV patients.

Meta-analysis (JAC, 2016): Bactrim showed superior activity in community-acquired MRSA skin infections vs clindamycin.

Guidelines: Recommended by IDSA for uncomplicated UTIs and PCP treatment/prophylaxis.

FAQs – Frequently Asked Questions
Q1: What infections does Bactrim treat?
Bactrim treats UTIs, respiratory infections, PCP, MRSA, and traveler’s diarrhea, among others.

Q2: Can I take Bactrim with food?
Yes, taking it with food or milk may help reduce stomach upset.

Q3: Is Bactrim safe during pregnancy?
It should be avoided during the first trimester and near delivery due to teratogenic and kernicterus risk.

Q4: How long does Bactrim take to work?
Clinical improvement is usually seen within 48–72 hours of starting treatment.

Q5: Can Bactrim be used in children?
Yes, but only for children over 2 months old with weight-adjusted dosing.

Q6: What to avoid while taking Bactrim?
Avoid excessive sun exposure, alcohol, and potassium-rich foods/supplements unless directed.

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