trimethoprim (TMP)

(trye meth' oh prim)

Primsol, Proloprim, Trimpex

Pregnancy Category C

Drug class
Antibacterial

Therapeutic actions
Inhibits the synthesis of nucleic acids and proteins in susceptible bacteria; the bacterial
enzyme involved in this reaction is more readily inhibited than the mammalian enzyme.

Indications
• Uncomplicated urinary tract infections caused by susceptible strains of E. coli,
Proteus mirabilis, Klebsiella pneumoniae, Enterobacter species, and coagulase-
negative Staphylococcus species, including Staphylococcus saprophyticus
• Treatment of acute otitis media due to susceptible strains of S. pneumoniae and H.
influenza in children

Contraindications and cautions

• Contraindicated with allergy to trimethoprim, pregnancy (teratogenic in
preclinical studies), megaloblastic anemia due to folate deficiency.
• Use cautiously with hepatic or renal dysfunction, lactation.

Available forms
Tablets—100, 200 mg; solution—50 mg/5 mL

Dosages
ADULTS
100 mg PO q 12 hr or 200 mg q 24 hr for 10 days.
PEDIATRIC PATIENTS
• Otitis media: 10 mg/kg/day in divided doses q 12 hr for 10 days.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL IMPAIRMENT
For creatinine clearance of 15–30 mL/min, 50 mg PO q 12 hr; creatinine clearance of <
15 mL/min, not recommended.

Pharmacokinetics
Route Onset Peak
Oral Varies 1–4 hr

Metabolism: Hepatic; T1/2: 8–10 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• Dermatologic: Rash, pruritus, exfoliative dermatitis
 • GI: Epigastric distress, nausea, vomiting, glossitis
• Hematologic: Thrombocytopenia, leukopenia, neutropenia, megaloblastic
anemia, methemoglobinemia, elevated serum transaminase and bilirubin,
increased BUN and serum creatinine levels
• Other: Fever

Nursing considerations
Assessment
• History: Allergy to trimethoprim, megaloblastic anemia due to folate deficiency,
renal or hepatic dysfunction, pregnancy, lactation
• Physical: Skin color, lesions; T; status of mucous membranes; CBC; liver and
renal function tests

Interventions
• Perform culture and sensitivity tests before beginning drug therapy.
• Protect the 200-mg tablets from exposure to light.
• Arrange for regular, periodic blood counts during therapy.
• Discontinue drug, consult with physician if any significant reduction in any
formed blood element occurs.

Teaching points
• Take the full course of the drug; take all the tablets prescribed.
• Have periodic medical checkups, including blood tests.
• These side effects may occur: Epigastric distress, nausea, vomiting (eat frequent
small meals); rash (consult with your health care provider for appropriate skin
care).
• Report fever, sore throat, unusual bleeding or bruising, dizziness, headaches, rash.

Adverse effects in Italic are most common; those in Bold are life-threatening.