Comparative Pharmacology
Head-to-head clinical analysis: COTRIM versus NITROFURANTOIN MONOHYDRATE MACROCRYSTALS.
Peer-Reviewed Evidence
Head-to-head clinical analysis: COTRIM versus NITROFURANTOIN MONOHYDRATE MACROCRYSTALS.
COTRIM vs NITROFURANTOIN (MONOHYDRATE/MACROCRYSTALS)
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
COTRIM is a combination of trimethoprim and sulfamethoxazole; sulfamethoxazole inhibits dihydropteroate synthase, and trimethoprim inhibits dihydrofolate reductase, sequentially blocking bacterial folate synthesis.
Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates that inhibit bacterial cell wall synthesis, protein synthesis, and DNA/RNA synthesis. It is bacteriostatic at low concentrations and bactericidal at higher concentrations.
1 double-strength tablet (160 mg trimethoprim + 800 mg sulfamethoxazole) orally every 12 hours for 5-14 days; 15-20 mg/kg/day (based on trimethoprim) IV divided every 6-8 hours for severe infections.
100 mg orally twice daily for 5-7 days; for uncomplicated urinary tract infection.
None Documented
None Documented
Sulfamethoxazole: 9-11 hours (normal renal function); trimethoprim: 8-10 hours. Extended in renal impairment (SMX up to 30h, TMP up to 24h).
Terminal elimination half-life: 20-60 minutes (average ~30 min) in patients with normal renal function; prolonged in renal impairment (e.g., CrCl <60 mL/min).
Renal: 50-70% unchanged sulfamethoxazole, 15-30% N4-acetylated metabolite; trimethoprim: 50-60% unchanged, 10-20% metabolites. Biliary/fecal: minimal.
Renal excretion of unchanged drug accounts for approximately 40% of the dose; tubular reabsorption occurs. Biliary/fecal elimination is minimal (<5%).
Category C
Category D/X
Antibiotic
Antibiotic