trimethoprim
Regulatory sources consulted
Approved indications
- Uncomplicated urinary infection, prophylaxis of recurrent urinary infection, and treatment of Pneumocystis jirovecii pneumonia combined with dapsone.
Contraindications
Absolute
- Hypersensitivity to trimethoprim or other diaminopyrimidines; severe blood dyscrasia; severe renal impairment without monitoring; age under 1 year; pregnancy or breastfeeding; and concomitant dofetilide treatment.
Clinical warnings
- Major warning · Blood dyscrasias and marrow suppression may occur; monitor blood counts, especially with high doses, prolonged treatment, folate deficiency, or renal impairment. — CIMA/AEMPS, ficha técnica 52547
- Major warning · Hyperkalemia may occur, especially with renal impairment or other potassium-raising drugs; monitor potassium and renal function. — CIMA/AEMPS, ficha técnica 52547
Drug interactions
- HighPotassium-raising drugs
Mechanism: Renin-angiotensin system inhibitors, potassium-sparing diuretics, and supplements increase hyperkalemia risk.
Recommendation: Monitor potassium and renal function; avoid the combination if risk cannot be controlled.
CIMA/AEMPS, ficha técnica 52547
- ModerateDofetilide
Mechanism: Trimethoprim inhibits renal dofetilide elimination, increasing exposure and arrhythmia risk.
Recommendation: Do not coadminister.
CIMA/AEMPS, ficha técnica 52547
- HighWarfarin
Mechanism: It may enhance the anticoagulant effect.
Recommendation: Monitor INR and adjust warfarin.
CIMA/AEMPS, ficha técnica 52547
- HighAntifolates, including methotrexate
Mechanism: They increase marrow suppression and folate deficiency.
Recommendation: Avoid if possible; if combined, monitor blood counts and folate.
CIMA/AEMPS, ficha técnica 52547
- ModerateDigoxin
Mechanism: Trimethoprim may increase digoxin concentrations.
Recommendation: Monitor digoxin concentrations and toxicity.
CIMA/AEMPS, ficha técnica 52547
Adverse events
Common (≥1%)
Nausea, vomiting, diarrhea, and rash
Rare but serious
Anaphylaxis, agranulocytosis, aplastic anemia, SJS/TEN, and hemolysis
Pregnancy and lactation
It is contraindicated during pregnancy and breastfeeding for this single-ingredient trimethoprim product.
Recent literature (PubMed)
These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of
Nocardiosis is an uncommon yet potentially devastating infection. Nocardia tends to affect individuals with chronic lung disease or immunocompromising conditions, 2 groups increasing in number. Incidence of nocardiosis is likely to increase as well, and it is vital to have an approach to this complex disease. Here, we aim to review the presentation, diagnosis, and management of Nocardia in the modern era. We will also highlight areas of uncertainty in our understanding of nocardiosis and propose a general approach to nocardiosis therapy, accounting for response and tolerance of Nocardia treatment. Because of the low levels of trimethoprim in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants.
This paper discusses the mechanisms of S. aureus drug resistance including: (1) introduction. (2) resistance to beta-lactam antibiotics, with particular emphasis on the mec genes found in the Staphylococcaceae family, the structure and occurrence of SCCmec cassettes, as well as differences in the presence of some virulence genes and its expression in major epidemiological types and clones of HA-MRSA, CA-MRSA, and LA-MRSA strains. Other mechanisms of resistance to beta-lactam antibiotics will also be discussed, such as mutations in the gdpP gene, BORSA or MODSA phenotypes, as well as resistance to ceftobiprole and ceftaroline. (3) Resistance to glycopeptides (VRSA, VISA, hVISA strains, vancomycin tolerance). (4) Resistance to oxazolidinones (mutational and enzymatic resistance to linezolid). (5) Resistance to MLS-B (macrolides, lincosamides, ketolides, and streptogramin B). (6) Aminoglycosides and spectinomicin, including resistance genes, their regulation and localization (plasmids, transposons, class I integrons, SCCmec), and types and spectrum of enzymes that inactivate aminoglycosides. (7). Fluoroquinolones (8) Tetracyclines, including the mechanisms of active protection of the drug target site and active efflux of the drug from the bacterial cell. (9) Mupirocin. (10) Fusidic acid. (11) Daptomycin. (12) Resistance to other antibiotics and chemioterapeutics (e.g., streptogramins A, quinupristin/dalfopristin, chloramphenicol, rifampicin, fosfomycin, trimethoprim) (13) Molecular epidemiology of MRSA.
Bacterial prostatitis is a highly prevalent infection responsible for significant morbidity among men. The diagnosis and treatment for bacterial prostatitis remains complicated. The difficulty in diagnosis is in part owing to the paucity of high-quality evidence that guides a clinician's interpretation of patients' history, physical examination, and laboratory findings. Treatment is challenging because of the few antimicrobials capable of prostate penetration, growing antimicrobial resistance limiting effective treatment options, and the high risk of recurrence. We aimed to provide a useful resource for clinicians in effectively diagnosing and managing acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP). A PubMed literature search on prostatitis was performed with no restrictions on publication date. The epidemiology, pathophysiology, diagnosis, and treatment for ABP and CBP are explored using a clinical vignette as relevant context. Bacterial prostatitis can be diagnosed through a focused history and microbiological investigations. The Meares-Stamey 4-glass test or modified 2-glass test can help confirm the diagnosis if uncertainty exists. Typical uropathogens are common contributors to bacterial prostatitis but there is growing interest in exploring the role atypical and traditional non-pathogenic organisms may have. Fluoroquinolones remain first-line therapy, followed by trimethoprim-sulfamethoxazole (TMP-SMX) or doxycycline if the pathogen is susceptible. Fosfomycin has emerged as a repurposed and useful agent because of the increasing incidence of multidrug-resistant pathogens. Selection of appropriate antimicrobial regimens can be challenging and is dependent on the host, chronicity of symptoms, uropathogens' susceptibilities, antimicrobials' side effect profile, and the presence of prostatic abscesses or calcifications. ABP can typically be treated similar to other complicated urinary tract infections. However, CBP requires prolonged the