#83 – Dosing Consult: Sulfamethoxazole/trimethoprim

#83 – Dosing Consult: Sulfamethoxazole/trimethoprim

Author: Society of Infectious Diseases Pharmacists July 21, 2023 Duration: 52:38
Breakpoints
HealthEducationScience

Episode Notes

In what has been described on Twitter as the “doing your own taxes of medicine,” Drs. Emily Heil (@emilylheil) and Andrew Fratoni (@AFratty) join Dr. Jillian Hayes (@thejillianhayes) to break down the ins and outs of sulfamethoxazole/trimethoprim dosing! Tune in for a discussion on the use of this agent for methicillin-resistant Staphylococcus aureus, gram-negatives, pneumocystis, and Stenotrophomonas maltophilia.

References:

  1. Twitter Thread re: Bactrim dosing: https://twitter.com/IDdocAdi/status/1661174505702674432?s=20
  2. PJP OI Guidelines: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/pneumocystis-0
  3. IDSA Resistant Gram Negative Guidance Document: https://www.idsociety.org/globalassets/idsa/practice-guidelines/amr-guidance/1.0/idsa-amr-guidance-v3.0.pdf
  4. (Lower doses of PJP Treatment): Butler-Laporte G, Smyth E, Amar-Zifkin A, Cheng M, McDonald E, Lee T. Low-dose TMP-SMX in the Treatment of Pneumocystis jirovecii Pneumonia: A Systematic Review and Meta-Analysis. Open Forum Infectious Diseases, Volume 7, Issue 5, May 2020, ofaa112, https://doi-org.proxy-hs.researchport.umd.edu/10.1093/ofid/ofaa112
  5. (DS Vs SS for PJP PPX): Schneider MM, Nielsen TL, Nelsing S, et al. Efficacy and toxicity of two doses of trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus. Dutch AIDS Treatment Group. J Infect Dis. 1995;171(6):1632-1636. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7769306.
  6. General Bactrim PK/PD: Trubiano JA, Grayson ML. Trimethoprim and Trimethoprim-Sulfamethoxazole (Cotrimoxazole). Chapter 92, Kucers’ The Use of Antibiotics (7th Edition). Taylor & Francis, 2017.
  7. (2014 IDSA SSTI Guidelines). PMID 24973422
  8. Cadena J, Nair S, Henao-Martinez AF, Jorgensen JH, Patterson JE, Sreeramoju PV. Dose of trimethoprim-sulfamethoxazole to treat skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2011 Dec;55(12):5430-2. doi: 10.1128/AAC.00706-11. Epub 2011 Sep 19. PMID: 21930870; PMCID: PMC3232808.
  9. Halilovic J, Heintz BH, Brown J. Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess. J Infect. 2012 Aug;65(2):128-34. doi: 10.1016/j.jinf.2012.03.013. Epub 2012 Mar 21. PMID: 22445732.
  10. Paul M, Bishara J, Yahav D, Goldberg E, Neuberger A, Ghanem-Zoubi N, Dickstein Y, Nseir W, Dan M, Leibovici L. Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial. BMJ. 2015 May 14;350:h2219. doi: 10.1136/bmj.h2219. PMID: 25977146; PMCID: PMC4431679.
  11. Lasko MJ, Gethers ML, Tabor-Rennie JL, Nicolau DP, Kuti JL. In Vitro Time-Kill Studies of Trimethoprim/Sulfamethoxazole against Stenotrophomonas maltophilia versus Escherichia coli Using Cation-Adjusted Mueller-Hinton Broth and ISO-Sensitest Broth. Antimicrob Agents Chemother. 2022 Mar 15;66(3):e0216721. doi: 10.1128/aac.02167-21. Epub 2022 Jan 10. PMID: 35007135; PMCID: PMC8923228.
  12. Lasko MJ, Tabor-Rennie JL, Nicolau DP, Kuti JL. Trimethoprim/sulfamethoxazole pharmacodynamics against Stenotrophomonas maltophilia in the in vitro chemostat model. J Antimicrob Chemother. 2022 Oct 28;77(11):3187-3193. doi: 10.1093/jac/dkac304. PMID: 36101486.

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Hosted by the Society of Infectious Diseases Pharmacists, Breakpoints is a podcast dedicated to the intricate and ever-evolving world of antimicrobial therapy. Each episode delves into the practical challenges and scientific nuances faced by pharmacists on the front lines of patient care, from interpreting susceptibility data and optimizing dosing strategies to navigating the complexities of antimicrobial stewardship. The conversations in this podcast bridge the gap between groundbreaking infectious diseases research and its direct application in clinical settings, offering insights that are both academically rigorous and immediately useful. You’ll hear expert discussions on new resistance patterns, evolving treatment guidelines, and the real-world implementation of life-saving protocols. Designed for healthcare professionals committed to precision medicine, Breakpoints provides a deeper understanding of how to effectively manage infections and improve patient outcomes. Tune in for thoughtful analysis and forward-thinking dialogue that defines the critical role of specialized pharmacists in public health.
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