sulfamethoxazole and trimethoprim
Regulatory sources consulted
Approved indications
- Urinary, respiratory, and gastrointestinal infections due to susceptible organisms, and treatment or prophylaxis of Pneumocystis jirovecii pneumonia.
Contraindications
Absolute
- Hypersensitivity to sulfamethoxazole, trimethoprim, or sulfonamides; severe hepatic disease; severe renal impairment without monitoring; severe blood dyscrasia or folate-deficiency megaloblastic anemia; porphyria; history of trimethoprim/sulfamethoxazole-induced immune thrombocytopenia; concomitant dofetilide treatment; and premature infants or infants younger than 6 weeks.
Clinical warnings
- Severe cutaneous reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, require immediate discontinuation at the first rash or mucosal signs. — CIMA/AEMPS, ficha técnica 58501
- 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 58501
- Major warning · Hyperkalemia may occur, especially with renal impairment or other potassium-raising drugs; monitor potassium and renal function. — CIMA/AEMPS, ficha técnica 58501
- Major warning · Hemolysis may occur in G6PD deficiency; avoid high doses and monitor for anemia. — CIMA/AEMPS, ficha técnica 58501
Drug interactions
- HighWarfarin and other coumarin anticoagulants
Mechanism: The combination may increase anticoagulant effect and INR.
Recommendation: Closely monitor INR and adjust the anticoagulant.
CIMA/AEMPS, ficha técnica 58501
- HighMethotrexate and other antifolates
Mechanism: They increase hematologic toxicity and folate deficiency.
Recommendation: Avoid the combination when possible; if essential, monitor blood counts and renal function.
CIMA/AEMPS, ficha técnica 58501
- HighPotassium-raising drugs
Mechanism: They increase trimethoprim-associated hyperkalemia risk.
Recommendation: Monitor potassium and renal function and avoid high-risk combinations.
CIMA/AEMPS, ficha técnica 58501
- ModerateDofetilide
Mechanism: Trimethoprim inhibits renal dofetilide elimination, increasing exposure and arrhythmia risk.
Recommendation: Do not coadminister.
CIMA/AEMPS, ficha técnica 58501
- HighPhenytoin, digoxin, and glucose-lowering drugs
Mechanism: Co-trimoxazole may increase their concentrations or effects.
Recommendation: Monitor concentrations, toxicity, or glucose and adjust as appropriate.
CIMA/AEMPS, ficha técnica 58501
Adverse events
Common (≥1%)
Nausea, vomiting, diarrhea, and rash
Rare but serious
Anaphylaxis, agranulocytosis, aplastic anemia, SJS/TEN, and hemolysis
Pregnancy and lactation
Avoid during pregnancy, especially in the first trimester and near delivery, unless benefit clearly outweighs risk and folate is considered; sulfonamides may displace bilirubin and cause kernicterus. Avoid breastfeeding if the infant is premature, a newborn, has jaundice, or has G6PD deficiency.
Recent literature (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