Trimethoprim + Sulfamethoxazole

Paul G. Auwaerter, M.D., Kathryn Dzintars, Pharm.D., BCPS
Pediatric Dosing Author: Alice Jenh Hsu, PharmD, BCPS, AQ-ID

INDICATIONS

Traveler’s diarrhea
Shigellosis
Otitis media (with documented sensitive S. pneumoniae)
AECB
- Due to susceptible strains of Haemophilus influenzae or Streptococcus pneumoniae.
Pneumocystis jiroveci pneumonia (PCP, treatment and prophylaxis)
Urinary tract infections
- uUTIs due to Escherichia coli, Klebsiellaand Enterobacter spp, Morganella morganii, Proteus mirabilis, and Proteus vulgari.
- Severe or complicated UTIs due to E. coli, Klebsiella and Enterobacter spp, M. morganii, P. mirabilis,and P. vulgaris.
Microbiologic indications (per prescribing information): likely active against most strains; however, increasing resistance seen for some spp. e.g., Klebsiella and Enterobacter. Check susceptibility profiles.
- Aerobic Gram-positive microorganisms:
  - Streptococcus pneumoniae
- Aerobic Gram-negative microorganisms:
  - Escherichia coli (including susceptible enterotoxigenic strains implicated in traveler’s diarrhea)
  - Klebsiella species
  - Enterobacter species
  - Haemophilus influenza
  - Morganella morganii
  - Proteus mirabilis
  - Proteus vulgaris
  - Shigella flexneri
  - Shigella sonnei
- Other Organisms:
  - Pneumocystis jiroveci

There are many off-label uses; the list is not comprehensive.
Nocardia
Toxoplasmosis (treatment and prophylaxis)
Bacterial cystitis prophylaxis
Isospora infections
Salmonella
MSSA and MRSA infections
Legionella (second line)
Listeria treatment (second-line for PCN-allergic patients, including meningitis)

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