Co-Trimoxazole An Overview of Safety and Efficacy

Co-trimoxazole use and
safety profile
For Healthcare Professionals only
Bactri
Tablet&syrup Sulfamethoxazole/Trimethoprim
Are we winning
the battle
but losing the
war?
Bactri
Reference:
ONeill, Jim, et al. (2014). Review on Antimicrobial resistance. Antimicrobial resistance: tackling a crisis for
the health and wealth of nations.
U.S. Department of Health and Human Services(2013). Antibiotic resistance threats in the United
Tablet&syrup Sulfamethoxazole/Trimethoprim States,2013.
Do you know?
Untuk menanggulangi Multi Drug Resistant (MDR), antibiotik yang

perlu dipertimbangkan adalah antibiotik kombinasi, salah satunya
adalah kombinasi trimethoprim - sulfametoxazole
Bactri
Reference:
Pogue,Jason M et al.(2011).Revisiting older antimicrobials in the era multidrug resistance. Pharmacotherapy
2011:31(9):912-921
Penyelamat pada Jutaan Kasus
Co-trimoxazole, the Bactrim was added In the era of

drug developed, to the list of multidrug-
produced, and essential resistant
marketed since
1969 as medicines (MDR), the use of
published by World TMP-SMX in certain
Bactrim
Health Organization infectious disease
(WHO)1 are re-considered2
PARTNE
R
Of Anti-
infectio
n
Bactri
Reference:
1
WHO.(2013). WHO Model List of Essential Medicines 18th List. WHO Press:Switzerland
2
Pogue,Jason M et al.(2011).Revisiting older antimicrobials in the era multidrug resistance. Pharmacotherapy 2011:31(9):912-921
Its
Legend
Its
Bactrim
Legenda
ry
Partner
of anti-
infectio
n
Bactri
Potensi
keuntungan dari
Co-trimoxazole
Bactri
Co-trimoxazole original dengan potensi
besar untuk menagani patogen
Pilihan
difusi yang yang baik
4 untuk semua
sangat
baik ke umur
dalam
jaringan dan 1
cairan tibuh
3
Potensi yang
baik untuk
Potensi menangani
yang baik 2 drug-resistant
untuk super-bug
menangani
penyakit berat
Bactri
Pilihan tepat untuk semua usia
Bactri
Reference:
Frank, U. et al. (2012). The Daschner guide to In-hospital antibiotic therapy. European standards 2nd edition. Germany:Springer
WHO. (2009). Pelayanan kesehatan anak di rumah sakit. Pedoman bagi rumah sakit rujukan tingkat pertama di kabupaten/kota
WHO.(2005). Handbook Integrated Management of Childhood Illness(IMCI). Switzerland: WHO publications
Gomolin, Irvin H.,et al.(2001). Efficacy and safety o ciprofloxacin oral suspension versus trimethoprim-sulfamethoxazole oral suspension for treatment of older women with
acute urinary tract infection. JAGS 49:12. pp. 1606-1613
Potensi besar untuk menangani drug-resistant super-bug
Acinetobacter
baumanii
Staphylococcus
aureus
Carbapenem
resistant
Enterobacteriaceae
Bactri
Reference:
Falagas,Matthew E.,et al.(2015). Trimethoprim/sulfamethoxazole for Acinetobacter spp.: A review of current microbiological and clinical evidence. International journal of antimicrobial agents.
Frei, christopher R., et al. (2010). Trimethoprim-sulfamethoxazole or clindamycin for community-associated MRSA (CA-MRSA) skin infections. JABFM 23:6. pp. 714-719
Paul, Mical, et al. (2015). Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by methicillin resistant Staphylococcus aureus: randomised controlled trial. BMJ 350.p 2219. doi:
10.1136/bmj.h2219
Goldberg, E. and J. Bishara. (2012). Contemporary unconventional clinical use of co-trimxazole. Clin Microbiol Infect 2012;18:18-17
Potensi besar untuk menangani penyakit yang membahayakan nyawa
Pneumocystis
jovenii
Stenotrophomonas
maltophilia
Burkholderia
pseudomallei
Nocardia spp.
Enterobacteriaceae
- extended-
spectrum -
lactamaseproducin
g
(ESBL)
Enterobacteriaceae
Bactri
Reference:
Ong,Catherine W.M., et al. (2009). Severe community-acquired Acinetobacter baumannii pneumonia: An emerging highly lethal infectious disease in the Asia-Pacific .
Respirology 14. p.1200-1206. doi: 10.1111/j.1440-1843.2009.01630.x
Brown,Glen R. (2014). Cotrimoxazole optimal dosing in the critically iill. Brown Annals of Intensive Care 4:13
Difusi yang baik ke dalam jaringan dan cairan tubuh
Good serum level
Good tissue
penetration
Good bacterial
activity in serum
TMP: 45% and

SMX:66% bound to
human plasma
proteins
Bactri
Reference:
Wormser,Gary P, et al. (1982). Co-trimoxazole (trimethoprim-sulfamethoxazole) An update review of its antibacterial activity and clinical efficacy. Drugs 24:459-518
Acar, J.F., et al. (1983). Inhibition of folate metabolism in chemotherapy: the origins and uses of co-trimoxazole. New York: Springer-Verlag Berlin Hiedelbergpage
Stein, Gary E., et al. (2013). Tissue penetration and antimicrobial activity of standard- and high-dose trimethoprim/sulfamethoxazole and linezolid in patients with diabetic
foot infection. J antimicrob Chemother. doi:10.1093/jac/dkt267
Data Sensitivitas Co-
trimoxazole terkini
Bactri
Co-trimoxazole: Spectrum of activity
Bacteria
(Sensitivity 75%)
Gram positive
bacteria
Gram negative
bacteria
Fungi
Bacteria (Sensitivity
Protozoa 50%)
Indole positive Proteus spp, Serratia marcescens,
Pseudomonas spp (nonaeruginosa),Providencia spp,
Campylobacter fetus, Achromobacter spp, Bacteroides
spp, Str faecalis,Toxoplasma gondii, Plasmodium spp,
Mycobacterium marinum, Legionella spp.
Resistance : Mycoplasma spp, Mycobacterium

tuberculosis, Pseudomonas aeruginosa dan Treponema
pallidum
Bactri
Reference:
BPOM.(2014).Product Information: Bactrim[Trimethoprim-
sulfamethoxazole].PP:1-8
Pola kerentanan TMP-SMX bervariasi pada Regio dan bakteri
yang berbeda
Pengetahuan terhadap Kerentanan

bakteri danpola resistensi terhadap
sulfamethoxazole/trimethoprim sangat penting
untuk keamanan dan efektivitas pemakaian obat
ini dalam setting klinis
Bactri
Pola kerentanan TMP-SMX pada Regio dan bakteri yang berbeda
100
90
80
70
60
Sensitivity Percentage 50
40
30
20
10
0
Chloro AMP TMP-SMX CRO CFP CAZ SCF MEM IMP CIP
2006 2007 2008 2009 2010

Chloro: Chloramphenicol; TMP-SMX: Trimethoprim-Sulfamethoxazole; AMP: Ampicillin; AMX: Amoxicillin; CRO: Ceftriaxone; CFX: Cefixime;
CAZ:ceftazidime; SCF: Cefoperazone; MEM: Meropenem; IMP: Imipenem; CIP:Ciprofloxacin;
Sejak 2006 sampai 2010, S.thyphi sebagai penyebab demam thypoid pada anak terbukti
masih sensitif pada chloramphenicol, ampisilin dan trimethoprim-sulfamethoxazole dan
merupakan lini pertama pada pengobatan penyakit ini
Bactri
Reference:
Alam,Anggraini.(2011).Resistance Pattern of Salmonella Enterica Serotipe Typhi, Departemen
Ilmu Kesehatan Anak RSHS, Tahun 2006-2010. Sari Pediatri, Vol 12, No 5.
Profil sesitivitas
Co-trimoxazole di
Asia
Tetracycline,
chloramphenicol
dan
cotrimoxazole
masih merupakan
pengobatan yang
baik untuk kasus
cholera
Secara empiris, pengobatan
suspek untuk
demam thypoid tanpa komplikasi masih
menggunakan chloramphenicol, cotrimoxazole
atau amoxicillin/ampicillin
Bactri
Reference:
Carlos,Celia C., et al. (2010). The 2009 antimicrobial resistance surveillance program: progress
report.
2010 11:2
Sensitivitas Antibiotik berdasarkan tes difusi dalam cawan, terhadap

Acinetobacter baumannii community-acquired pneumonia
Patient 1 2 3 4 5 6 7 8
Blood -
Site of
Rejec Reject
cultures
Sputum ND ted ed
WCC 4+ 2+ - 3+ - 3+ 1+ -
Sputum
EC 0 0 - 0 - 0 0 -
smear
GNB 4+ 1+ - 1+ - 3+ 3+ -
Ampicillin R R R R R R R R
AMC ND ND ND R I R S I
Ceftriaxone ND ND ND I I I R I
Ceftazidim
e S I I ND ND I I S
SAM S S S S S S S S
Sensitivity
Ciprofloxaci
n S S S S S S S S
Co-
trimoxazole S S S S S S S S
Gentamicin S S S S S S S S
Kerentanan Acinetobacter baumannii yand diisolasi terhadap antibiotik: semua sensitif terhadap
Imipenem
ampicillin/sulbactam, ciprofloxacin,Sco-trimoxazole,
S Saminoglycosides
S S dan imipenem
S S 11 S
Bactri
Reference:
ONG,Catherine W.M.,et al. (2009). Severe community-acquired Acinetobacter baumannii
pneumonia: An emerging highly lethal infectious disease in the AsiaPacific. Respirology (2009)
14, 12001205.doi: 10.1111/j.1440-1843.2009.01630.x
Aktivitas agen antimikroba ketika dilakukan tes terhadap

isolasi GNB di China
TMP-SMX adalah salah satu dari antimikroba tertua yang masih

ampuh terhadap Serratia marcescens
Bactri
Reference:
Jones, Ronald N.,et al.(2013). Update of contemporary antimicrobial resistance rates across
China: reference testing results for 12 medical centers (2011).Diagnostic Microbiology and
Infectious Disease 77 (2013) 258266.doi:10.1016/j.diagmicrobio.2013.07.003
Clinical Evidence
Terkini
Bactri
Rekomendasi terapi terhadap patogen gastrointestinal
Pathogen Immunocompetent patients
TMP-SMZ, 160 and 800 mg, respectively (pediatric dose, 5 and 25 mg/kg, respectively) b.i.d. 3
3 d (if susceptiblea) or fluoroquinoloneb(e.g., 300 mg ofloxacin, 400 mg norfloxacin [186], or 500
mg ciprofloxacin b.i.d. 3 3 d) (A-I) (adults) 3 5 d [220] or ceftriaxone [79]; azithromycin [121] [117
Shigella species 121]; nalidixic acid, 55 mg/kg/d (pediatric) or 1 g/d
Not recommended routinely (E-I) [59,60], but if severe or patient is !6 mo or 150 y old or has
prostheses, valvular heart disease, severe atherosclerosis, malignancy, or uremia, TMP-SMZ (if
Non-typhi species of susceptible) or fluoroquinoloneb as above, b.i.d. 3 57 d (B-III) [29, 132, 221]; ceftriaxone, 100
Salmonella mg/kg/d in 1 or 2 divided doses [222]
Campylobacter species Erythromycin, 500 mg b.i.d. 3 5 dc (B-II) [122, 123]
Escherichia coli species
TMP-SMZ, 160 and 800 mg, respectively, b.i.d., 3 3 d (if susceptible), or (A-I) [152, 153,
168]fluoroquinoloneb (e.g., 300 mg ofloxacin,400 mg norfloxacin, or 500 mg ciprofloxacin b.i.d. 3
Enterotoxigenic 3 d)
Enteropathogenic As above (B, II) [188]
Enteroinvasive As above (B-II) [171, 178]
Enteroaggregative Unknown (C-III)
Avoid antimotility drugs (E-II) [136]; role of antibiotics unclear,and administration should be
Enterohemorrhagic (STEC) avoidedd (C-II) [52, 5456 ,67, 181]
TMP-SMZ, 160 and 800 mg, respectively, b.i.d. 3 3 d (if susceptible),fluoroquinoloneb (e.g., 300
mg ofloxacin, 400 mg norfloxacin, or 500 mg ciprofloxacin b.i.d. 3 3 d) (B-III) [146, 160162, 172,
Aeromonas/Plesiomonas 179]
Antibiotics are not usually required (C-II) [149, 174, 175]; deferoxamine therapy should be
withheld (B-II)[149, 182]; for severe infections or associated bacteremia treat as for
immunocompromised hosts, using combination therapy with doxycycline, aminoglycoside, TMP-
Yersinia species SMZ, or fluoroquinolone (B-III) [149, 184]
Doxycycline, 300-mg single dose; or tetracycline, 500 mg q.i.d. 3 3 d; or TMP-SMZ, 160 and
Vibrio cholerae O1 or O139 800 mg, respectively,b.i.d. 3 3 d; or single-dose fluoroquinoloneb (A-I) [142,144, 158, 163, 164]
Toxigenic Clostridium Offending antibiotic should be withdrawn if possible (B-II) [154, 157, 187]; metronidazole, 250 mg
difficile q.i.d. to 500 mg t.i.d. 3 10 d (A-I) [173, 187, 189]
Parasites
Giardia Metronidazole, 250750 mg t.i.d. 3 710 d (A-I) [143, 165,166]
Cryptosporidium species If severe, consider paromomycin, 500 mg t.i.d. 3 7 d, as with immunocompromised hosts (C-III)
Isospora species TMP-SMZ, 160 and 800 mg, respectively, b.i.d. 3 710 d (BIII)
Cyclospora species TMP/SMZ, 160 and 800 mg, respectively, b.i.d. 3 7 d (A-I) [159, 167]
Bactri
Reference:
Guerrant, Richard L., et al. (2001). Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases 32.
pp:331-350
Tetap menjadi pengobatan yang teruji untuk Urinary Track Infection pada anak
Perbedaan diantara 2
grup studi : 6
percentage points (95%
Waktu munculnya
CI, 1 to 13)1
simptom Tract
Infection (Primary Antibiotic group hazard
Outcome) ratio : 0.61, 95% [CI],
0.40 to 0.93, P=0.021

Perbedaan diantara 2
grup : 6 percentage
Waktu munculnya points (95%, 1 to 11)1
demam pada Urinary
Tract Infection Hazard ratio : 0.49, 95%
(Secondary Outcome) [CI], 0.28 to 0.86,
P=0.011

Pemakaian trimethoprim-sulfamethoxazole Dosis rendah dalam jangka

waktu lama berhubungan dengan Penurunan jumlah kasus UTI pada
anak1 Abbreviation: UTI: Urinary Tract Infection
Bactri
Reference:
Craig,Jonathan C., et al(2009). Antibiotic prophylaxis and recurrent urinary tract
infection. N EngI J Med 361:1748-59.
Co-trimoxazole: First line therapy pada Pnemocystis jirovecii
pneumonia
TMP-SMX memiliki keunggulan pada penetrasi jaringan,

merupakan terapi dengan respon tercepat sebagai anti-
Pneumocystis agents dan memiliki bioavailabilitas yang sama baik
(oral therapy) dibandingkan dengan pemberian parenteral
Bactri
Reference:
Fishman, Jay Alan. (1998). Trestment of infection due to Pneumocystis cariniii. Antimicrobial
agents and chemotherapy, June 1998,p. 1309-1314
Co-trimoxazole:mengurangi tingkat kekambuhan dari Toxoplasma
retinochoroiditis
48
No of Patients
47 0 Without Recurrence
46 69
45 76
44 126
43 140
42 144
41 324 365
40
39
38
0 69 76 126 140 144 324 365
TMP-SMX Placebo
Days Follow up
Mean Interval
Between the pre-enrollment recurrence episode and the first
recurrence observed during study follow-up: 146 (SD 93)
Trimethoprim-sulfamethoxazole tmemiliki hasi penurunan rekurensi
Toxoplasma gondii retinochoroiditis sebesar 100% selama 1 tahun
pengobatan
Bactri
Reference:
Felix, JPF et al. (2014). Trimethoprim-Sulfamethoxazole Versus Placebo to Reduce the Risk of Recurrences
of Toxoplasma Gondii Retinochoroiditis: Randomized Controlled Clinical Trial. Am K Ophtalmol:157:762-766
Co-trimoxazole: dalam pengobatan kasus infeksi yang
membahayakan nyawa
Target concentrations for selected pathogens
Organism Target Target concentration
concentration sulfamethoxazole
trimethoprim (mcg/ml
(mcg/ml)
Pneumocystis jirovecii 5 to 8 Cmax 100 to 200 mcg/ml Cmax
Stenotrophomonas >6 Cmax > 60 Cmax

maltophilia
Burkholderia pseudomallei 2 Cmin 38 Cmin
Nocardia 4 Cmin 76 Cmin
Methicillin-resistant 2 Cmin 38 Cmin

Staphylococcus aureus
ESBLEnterobacteriaceae 2 Cmin 38 Cmin
Cmax, Maximum concentration during dosing interval
Cmin, Minimum concentration during dosing interval
TMP/SMX merupakan pilihan treatment utama untuk pasien kritis dengan infeksi yang
disebabkan oleh patogen sensitif
TMP/SMX harus diberikan dengan dosis dan frekuensi pemberian yang cukup untuk memperoleh hasil
yang adekuat pada tempat infeksi
Bactri
Reference:
Brown,Glen R. (2014). Cotrimoxazole optimal dosing in the critically iill. Brown Annals of
Intensive Care 4:13
Profil Keamanan
Bactri
Sejak pertama kali dipasarkan, keamanan obat masih tetap
dimonitor dan dilaporkan
Patient Exposure Contraindications

Sejak pertama kali dipasarkan dan Liver parenchymal damage
mendapat pengakuan di austria pada
1 april 1969, dan sampai akhir Renal impairment
pelaporan (31 March 2014),
sulfamethoxazole / trimethoprim Blood dyscrasias
sudah diakui dan dipakai oleh 100
negara di dunia Stevens-Johnson syndrome
Toxic Epidermal Necrolysis and

liver necrosis
Hypersensitive of sulphanamide
and trimethoprim
Pregnancy
Premature and newborn infants

during the first few weeks
Bactri
Reference:
BPOM.(2014).Product Information: Bactrim[Trimethoprim-sulfamethoxazole].PP:1-8
Ciorciaro,Cornelia.(2014).PBER/PSUR Bactrim/ Sulfamethoxazole/trimethoprim. UK: Roche
Gastrointestinal and cutaneous symptom are adverse
event that usually appear. Usually mild, dose-related-
reversible and did not require discontinuation9
Gastrointestinal intolerance occurs in the range of
3-8% of patients worldwide 9
Dermatologic reaction occurs 3-4% of the population

who received therapy with TMP-SMX9. Serious reaction
such as, Steven-Johnson syndrome and toxic
epidermal necrolysis are very rare, perhaps occurring
in 1 to 6 per million population 24
Hematologic reactions frequency: 50 million daily

doses an frequency of fatal reactions to TMP-SMX was
calculated to be 3.7/million treatment(data from
SWEDIS, Medical products Agency,Uppsala, Sweden)25
Bactri
Reference:
Masters,Philip A et al. (2003). Trimethoprim-sulfamethoxazole Revisited. Arch Intern Med:163:402-410
Al-Johani KA, Fedele S, Proter SR. Erythema multiforme and related disorders. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2007;103:642-54.
Norrby SR. Folate inhibitors. In: Cohen J, Powderly WG,editors. Infectious diseases. St Louis, MO: Mosby; 2004.
Tablet&syrup Sulfamethoxazole/Trimethoprim p.1823.
Children population
Frekuensi tersering: gastrointestinal (mual, muntah, dan diare)
dan rash (occuring in 3-4% patients)
Spektrum reaksi kulit yang terjadi terhadao TMP/SMX meliputi

urticaria, maculopapular rash, fixed drug eruption, erythema
multiforme, Stevens-Johnson syndrome (SJS) and toxic epidermal
necrolysis (TEN)
Insiden SJS dalam beberapa populasi studi 1.2 to 6.1 per juta
orang per tahun
Insiden dari TEN: 0.4 to 1 kasus per juta orang per tahun
Kasus dyscrasiass yang paling sering dalam darah meliputi anemia
aplastik, agranulocytosis dan trombositopeniai. Insiden dari blood
dyscrasia: 0.7 and 0.2 kejadian blood dyscrasia per 100 tahun
dalam resiko pada anak usia 2 to 15 tahun
Bactri
Reference:
Radiol Endod 2007;103:642-54.
Populasi dewasa
Abnormalitas hematologi abnormalities, meliputi
thrombocytopenia, leukopenia, agranulocytosis, anemia, dan
eosinophilia, dilaporkan pada 0.5% orang dewasa yang
menerima terapi oral TMP-SMX
Toksisitas Hepar: Hepatocellular (40%), mixed (40%) dan cholestatic
(20%) injuries merupakan reaksi patologi yang paling banyak
dilaporkan pada orang dewasa. Insiden dari reaksi efek samping
dilaporkan 1/11,000 to 1/45,000 treatments
Bactri
Reference:
Radiol Endod 2007;103:642-54.
Profil Bactrim
Bactri
Co-trimoxazole: mekanisme aksi
TMP-SMX meng-
inhibisi synthesis
of asam
tetrahydrofolic
acid bakteri
Tetrahydrofolic
acid bentuk
aktif asam folat
dan cofaktor
dari sintesis
DNA bakteri
Bactri
Reference:
BPOM.(2014).Product Information: Bactrim[Trimethoprim-
sulfamethoxazole].PP:1-8
Co-trimoxazole: Mekanisme aksi dibalik kemampuan antimikroba
Immunomodulator Anti-inflamasi Terkonsentrasi di dalam sel
Bactri
Reference:
Church,James A., et al., (2015). The expanding role of co-trimoxazole In developing countries. Lancet Infect Dis 15:327-39.
http://dx.doi.org/10.1016/S1473-3099(14)71011-4
Co-trimoxazole: Packaging
Bactrim Syrup Bactrim Forte

HNA Rp 70.894,-/bottle HNA Rp 547.646,-/box 20 blister
Sulfamethoxazole/Trimethoprim @5 tabs
(200 mg/40 mg) Sulfamethoxazole/Trimethoprim
(800 mg/160 mg)
Bactri
Reference:
Co-trimoxazole: dosis dan cara penggunaan
Bactrim
Adults and children above 12 years old
Tablet ForteDosage Bactrim Forte tab
Morning Evening
Standard dosage 1 1
Minimum dosage and long-term
therapy (longer than 14 days)
High dosage (for severe cases) 1 1
Bactrim Syrup : Dosage for

Children
Dosage 1 measuring spoon (5 ml)
Bactrim syrup
Morning Evening
8 weeks-5 month
6 month-5 years 1 1
6 years-12 years 2 2
Bactrim sebaiknya diberikan dengan jumlah air minum yang cukup untuk mencegah
crystalluria, pemberian setelah makan lebih dianjurkan.
Pada kasus infeksi yang parah, dosis anak sebaiknya ditingkatakan sampai50%
Bactri
Reference:
Co-trimoxazole: dosis dan pemakaian
Special
Instruction
Usage Dosage
Gonorrheae Adult: 2 forte film-coated tablets dua kali sehari
Uncomplicated acute Direkomendasikan pembelrian 2-3 dosis tunggal tablet forte film-
urinary tract infections coated
Pneumonia Pneumocystis carinii Sampai 20 mg trimethoprim per kg dan sampai100 mg

sulfamethoxazole per kg per 24 jam, diberikan dengan dosis terbagi
setiap 6 jam sampai 14 hari
Renal dysfunctions
Creatinine clearance: Recommended dosage schedules:

More than 30ml/min Standard dosage
15-30 ml/min Half standard dosage
Less than 15 ml//min Use of Bactrim is not recommended
Bactri
Reference:
Co-trimoxazole general dengan potensi besar untuk
melawan patogen
1
Sebagai Partner anti-infeksi
2
Dua aksi kemoterapetik dengan
difusi yang baik ke dalam jaringan
dan cairan
3 Sanat penting sebagai anti infeksi
untuk menyelamatkan infeksi yang
membahayakan nyawa
4
Sebagai terapi yang
dipertimbangkan untuk infeksi MDR
Bactri
Doing now what patients
need next

Co-Trimoxazole An Overview of Safety and Efficacy

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Co-Trimoxazole An Overview of Safety and Efficacy

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Co-trimoxazole use and

For Healthcare Professionals only

Untuk menanggulangi Multi Drug Resistant (MDR), antibiotik yang

Co-trimoxazole, the Bactrim was added In the era of

Good serum level

TMP: 45% and

Resistance : Mycoplasma spp, Mycobacterium

Pengetahuan terhadap Kerentanan

2006 2007 2008 2009 2010

Sensitivitas Antibiotik berdasarkan tes difusi dalam cawan, terhadap

Aktivitas agen antimikroba ketika dilakukan tes terhadap

TMP-SMX adalah salah satu dari antimikroba tertua yang masih

Pemakaian trimethoprim-sulfamethoxazole Dosis rendah dalam jangka

TMP-SMX memiliki keunggulan pada penetrasi jaringan,

Stenotrophomonas >6 Cmax > 60 Cmax

Nocardia 4 Cmin 76 Cmin

Methicillin-resistant 2 Cmin 38 Cmin

Patient Exposure Contraindications

Toxic Epidermal Necrolysis and

Premature and newborn infants

Dermatologic reaction occurs 3-4% of the population

Hematologic reactions frequency: 50 million daily

Spektrum reaksi kulit yang terjadi terhadao TMP/SMX meliputi

Immunomodulator Anti-inflamasi Terkonsentrasi di dalam sel

Bactrim Syrup Bactrim Forte

High dosage (for severe cases) 1 1

Bactrim Syrup : Dosage for

Pneumonia Pneumocystis carinii Sampai 20 mg trimethoprim per kg dan sampai100 mg

Creatinine clearance: Recommended dosage schedules:

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