sulfamethoxazole and trimethoprim
Fuentes regulatorias consultadas
Indicaciones aprobadas
- Infecciones urinarias, respiratorias y gastrointestinales por microorganismos sensibles, y tratamiento o profilaxis de neumonía por Pneumocystis jirovecii.
Contraindicaciones
Absolutas
- Hipersensibilidad a sulfametoxazol, trimetoprim o sulfonamidas; hepatopatía grave; insuficiencia renal grave sin monitorización; discrasia sanguínea grave o anemia megaloblástica por déficit de folato; porfiria; antecedente de trombocitopenia inmune inducida por trimetoprim/sulfametoxazol; tratamiento concomitante con dofetilida; y prematuros o lactantes menores de 6 semanas.
Advertencias clínicas
- Las reacciones cutáneas graves, incluidos síndrome de Stevens-Johnson y necrólisis epidérmica tóxica, requieren suspensión inmediata ante erupción o signos mucosos. — CIMA/AEMPS, ficha técnica 58501
- Advertencia mayor · Puede causar discrasias sanguíneas y supresión medular; controla hemograma, especialmente con dosis altas, tratamiento prolongado, déficit de folato o insuficiencia renal. — CIMA/AEMPS, ficha técnica 58501
- Advertencia mayor · Puede causar hiperpotasemia, especialmente con insuficiencia renal o con otros fármacos que elevan el potasio; controla potasio y función renal. — CIMA/AEMPS, ficha técnica 58501
- Advertencia mayor · En déficit de G6PD puede causar hemólisis; evita dosis altas y vigila signos de anemia. — CIMA/AEMPS, ficha técnica 58501
Interacciones medicamentosas
- SeveraWarfarina y otros anticoagulantes cumarínicos
Mecanismo: La combinación puede aumentar el efecto anticoagulante y el INR.
Recomendación: Controla estrechamente el INR y ajusta el anticoagulante.
CIMA/AEMPS, ficha técnica 58501
- SeveraMetotrexato y otros antifolatos
Mecanismo: Aumentan la toxicidad hematológica y el déficit de folato.
Recomendación: Evita la combinación cuando sea posible; si es imprescindible, controla hemograma y función renal.
CIMA/AEMPS, ficha técnica 58501
- SeveraFármacos que elevan el potasio
Mecanismo: Aumentan el riesgo de hiperpotasemia por trimetoprim.
Recomendación: Controla potasio y función renal y evita combinaciones de alto riesgo.
CIMA/AEMPS, ficha técnica 58501
- ModeradaDofetilida
Mecanismo: Trimetoprim inhibe la eliminación renal de dofetilida y aumenta su exposición y el riesgo de arritmia.
Recomendación: No administrar conjuntamente.
CIMA/AEMPS, ficha técnica 58501
- SeveraFenitoína, digoxina e hipoglucemiantes
Mecanismo: Cotrimoxazol puede aumentar sus concentraciones o efectos.
Recomendación: Controla concentraciones, toxicidad o glucemia y ajusta según corresponda.
CIMA/AEMPS, ficha técnica 58501
Eventos adversos
Comunes (≥1%)
Náuseas, vómitos, diarrea y erupción cutánea
Raros pero graves
Anafilaxia, agranulocitosis, anemia aplásica, SJS/TEN y hemólisis
Embarazo y lactancia
Evita durante el embarazo, especialmente en el primer trimestre y cerca del parto, salvo que el beneficio supere claramente el riesgo y se valore folato; las sulfonamidas pueden desplazar bilirrubina y causar kernícterus. Evita la lactancia si el lactante es prematuro, neonato, tiene ictericia o presenta déficit de G6PD.
Bibliografía reciente (PubMed)
Over the last few decades, the occurrence of pharmaceuticals and personal care products (PPCPs) in aquatic environments has generated increasing public concern. In this review, data on the presence of PPCPs in environmental compartments from the past few years (2014-2022) are summarized by carrying out a critical survey of the partitioning among water, sediment, and aquatic organisms. From the available articles on PPCP occurrence in the environment, in Web of Science and Scopus databases, 185 articles were evaluated. Diclofenac, carbamazepine, caffeine, ibuprofen, ciprofloxacin, and sulfamethoxazole were reported to occur in 85% of the studies in at least one of the mentioned matrices. Risk assessment showed a moderate to high environmental risk for these compounds worldwide. Moreover, bioconcentration factors showed that sulfamethoxazole and trimethoprim can bioaccumulate in aquatic organisms, while ciprofloxacin and triclosan present bioaccumulation potential. Regarding spatial distribution, the Asian and European continents presented most studies on the occurrence and effects of PPCPs on the environment, while Africa and Asia are the most contaminated continents. In addition, the impact of COVID-19 on environmental contamination by PPCPs is discussed.
The occurrence of contaminants of emerging concern (CECs) in environmental systems is gradually more studied worldwide. However, in Latin America, the presence of contaminants of emerging concern, together with their environmental and toxicological impacts, has recently been gaining wide interest in the scientific community. This paper presents a critical review about the source, fate, and occurrence of distinct emerging contaminants reported during the last two decades in various countries of Latin America. In recent years, Brazil, Chile, and Colombia are the main countries that have conducted research on the presence of these pollutants in biological and aquatic compartments. Data gathered indicated that pharmaceuticals, pesticides, and personal care products are the most assessed CECs in Latin America, being the most common compounds the followings: atrazine, acenaphthene, caffeine, carbamazepine, ciprofloxacin, diclofenac, diuron, estrone, losartan, sulfamethoxazole, and trimethoprim. Most common analytical methodologies for identifying these compounds were HPLC and GC coupled with mass spectrometry with the potential to characterize and quantify complex substances in the environment at low concentrations. Most CECs' monitoring and detection were observed near to urban areas which confirm the out-of-date wastewater treatment plants and sanitization infrastructures limiting the removal of these pollutants. Therefore, the implementation of tertiary treatment should be required. In this tenor, this review also summarizes some studies of CECs removal using electrochemical advanced oxidation processes that showed satisfactory performance. Finally, challenges, recommendations, and future perspectives are discussed.
With growing concerns regarding the ecological and human risks of organic micropollutants (OMPs) in water, much effort has been devoted worldwide to establishing quality standards and compiling candidate and watch lists. Although bank filtration is recognized as an efficient natural water treatment in the removal of contaminants such as OMPs, the increase in exploitation requires continuous assessment of removal efficiency. This review aims to provide a critical overview of bank filtration (BF) reports on more than a hundred priority substances (PSs) and compounds of emerging concern (CECs) listed in the relevant European Union regulations. Field- and lab-scale studies analyzing the removal efficiency and its variance of individual OMPs and biological indicators using BF and the main influencing factors and their interactions, shortcomings, and future challenges are discussed in this review. The removal efficiency of EU-relevant contaminants by BF has been comprehensively investigated for only a few pollutants listed in the environmental EU regulations: pharmaceutically active compounds, (e.g., the anti-inflammatory drug diclofenac, some antibiotics (e.g., sulfamethoxazole and trimethoprim)), a few pesticides (e.g., atrazine), and faecal indicators such as Escherichia coli. In many cases, the measured concentrations of PSs and CECs have not been published numerically, which hinders comprehensive statistical analysis. Although BF is one of the most cost-effective and efficient water treatments, present field and lab studies have demonstrated the diversity of site-specific factors affecting its efficiency. Even in the case of substances known to be removed by BF, the efficiency rates can vary with environmental and anthropogenic factors (e.g., hydrogeological parameters and the contamination level of infiltrating water) and abstraction well parameters (e.g., the depth, distance, and pumping volume). The published removal rate variations and influencing factors often r
Antibiotic pollution in aquatic environments is a growing global concern, posing risks to ecosystem health and human well-being. The African continent faces increasing challenges in addressing this issue, necessitating a comprehensive understanding of the current state of research and regional trends. This review synthesizes evidence on the occurrence and distribution of antibiotics in aquatic environments in the African continent, assessing concentration levels and evaluating the potential environmental and microbial risks using predicted no-effect concentrations (PNECs). A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was conducted to identify relevant studies published between January 1, 2015, and November 13, 2024, reporting antibiotic concentrations in surface water, groundwater, drinking water, and wastewater from countries within the African continent. The review encompassed 19 studies reporting antibiotic concentrations in aquatic environments from 8 African countries, with the majority being conducted in South Africa. Surface water was the most frequently sampled environment. Twenty-six antibiotics from various classes were identified, with sulfamethoxazole and trimethoprim being the most frequently detected. Surface water and wastewater exhibited the highest numbers of antibiotics. Antibiotic concentrations fluctuated over time, peaking in 2020 and 2021. Wastewater had the highest concentrations, with norfloxacin levels reaching up to 433.0000 µg/L, while drinking water had the lowest concentrations. In many instances, detected concentrations surpassed PNEC-ENV and PNEC-MIC values, indicating potential environmental and microbial risks. This review underscores the threatening high concentrations levels of antibiotic in African aquatic environments, particularly in wastewater and surface waters. The presence and levels of some antibiotics exceeding the PNEC thresholds raises concerns because they can foster the development and spre