Comparative Pharmacology
Head-to-head clinical analysis: COTRIM versus SULFAMETHOXAZOLE AND TRIMETHOPRIM SINGLE STRENGTH.
Peer-Reviewed Evidence
Head-to-head clinical analysis: COTRIM versus SULFAMETHOXAZOLE AND TRIMETHOPRIM SINGLE STRENGTH.
COTRIM vs SULFAMETHOXAZOLE AND TRIMETHOPRIM SINGLE STRENGTH
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.
Sulfamethoxazole inhibits bacterial dihydropteroate synthase, blocking folate synthesis. Trimethoprim inhibits bacterial dihydrofolate reductase, blocking tetrahydrofolate synthesis. Together, they provide sequential blockade of folate metabolism, leading to bactericidal activity.
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.
1 double-strength tablet (800 mg sulfamethoxazole/160 mg trimethoprim) orally every 12 hours for most infections; single-strength tablet (400 mg/80 mg) is used for prophylaxis: 1 tablet orally daily.
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).
Sulfamethoxazole: 10-12 hours (prolonged in renal impairment); Trimethoprim: 8-11 hours (prolonged in hepatic impairment).
Renal: 50-70% unchanged sulfamethoxazole, 15-30% N4-acetylated metabolite; trimethoprim: 50-60% unchanged, 10-20% metabolites. Biliary/fecal: minimal.
Sulfamethoxazole: primarily renal (70-90% as unchanged drug and acetylated metabolite); Trimethoprim: renal (50-60% unchanged, rest as metabolites); small biliary/fecal elimination (<5% each).
Category C
Category D/X
Antibiotic
Antibiotic