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Relapse has occurred occasionally during co-trimoxazole therapy but may respond to supplemental dosages of trimethoprim or the addition of small dosages of cytotoxic therapy. In HIV-infected children 1-5 years of age, primary prophylaxis against PCP should be initiated if CD4 T-cell counts are less than 500/ mm or the CD4 percentage is less than 15%. Trimethoprim is metabolized to oxide and hydroxylated metabolites and sulfamethoxazole is principally Only small amounts of trimethoprim are excreted in feces via biliary elimination. Following multiple-dose oral administration, steady-state peak serum concentrations usually are 50% greater than those obtained after single-dose administration of the drug.
To decrease the incidence of relapse, many clinicians recommend that rifampin be used in conjunction with co-trimoxazole or a tetracycline. In addition, at the time prophylaxis was discontinued, most patients had CD4 T-cell counts exceeding 200/ mm for at least 3 months and many patients had sustained plasma HIV-1 RNA levels below the detection limits of the available assays. Some evidence indicates that co-trimoxazole may be better tolerated in HIV-infected children than adults. Patients receiving co-trimoxazole should be cautioned to maintain adequate fluid intake to prevent crystalluria and stone formation.Co-trimoxazole should be used with caution in geriatric patients, particularly when complicating conditions (e.g., impaired renal and/or hepatic function, concomitant use of other drugs) are present, since these patients may have an increased risk of severe adverse reactions to the drug. Trimethoprim serum half-lives of about 7.7 and 5.5 hours have been reported in children less than 1 year of age and between 1 and 10 years of age, respectively.Both trimethoprim and sulfamethoxazole are metabolized in the liver.
HIV-infected adults and adolescents with a CD4 T-cell percentage of less than 14% or a history of an AIDS-defining illness who do not otherwise qualify for prophylaxis also should be considered for primary prophylaxis. Alternative regimens that can be used in HIV-infected infants and children include dapsone, aerosolized pentamidine, or atovaquone.The safety of discontinuing primary or secondary PCP prophylaxis in HIV-infected children receiving potent antiretroviral therapy has not been extensively studied.
If signs of bone marrow suppression occur in patients receiving co-trimoxazole, leucovorin should be administered; some clinicians recommend a leucovorin dosage of 5-15 mg daily until normal hematopoiesis is restored.Nausea, vomiting, and anorexia are the most frequent GI reactions to co-trimoxazole, but glossitis, stomatitis, abdominal pain, pancreatitis (sometimes fatal), pseudomembranous enterocolitis, and diarrhea also have been reported.Pain, local irritation, inflammation, and rarely thrombophlebitis may occur with IV co-trimoxazole, especially if extravascular infiltration of the drug occurs.Adverse nervous system effects of co-trimoxazole include headache, insomnia, fatigue, apathy, nervousness, muscle weakness, ataxia, vertigo, tinnitus, peripheral neuritis, mental depression, aseptic meningitis, seizures, and hallucinations. These adverse effects usually recur following rechallenge with the drug, although cautious desensitization has been performed successfully in some patients in whom continued co-trimoxazole therapy was considered necessary. Secondary prophylaxis generally is administered for life, unless immune recovery has occurred as a result of potent antiretroviral therapy.Current evidence indicates that secondary PCP prophylaxis can be discontinued in HIV-infected adults and adolescents responding to potent antiretroviral therapy who have a sustained (3 months or longer) increase in CD4 T-cell counts from less than 200/ mm to greater than 200/ mm.
Reproduction studies in rats using oral trimethoprim (as co-trimoxazole) dosages up to 70 mg/kg daily have not revealed evidence of impaired fertility.Co-trimoxazole is distributed into milk. This medicine will not treat a This medicine can affect the results of certain medical tests. Check with your FSA Administrator about reimbursement procedures for your plan.The FSA Debit Card would not be charged if something is not considered FSA eligible under your plan. Because sulfonamides may cause kernicterus in infants younger than 2 months of age, a decision should be made whether to discontinue nursing or co-trimoxazole or to use an alternative drug, taking into account the importance of co-trimoxazole to the woman.Co-trimoxazole may prolong the prothrombin time (PT) of patients receiving concomitant warfarin by inhibiting metabolic clearance of warfarin.
The exact mechanism(s) of this increased risk of co-trimoxazole toxicity has not been determined, but may be immunologically based. However, because of the development of resistance to co-trimoxazole in many areas, other anti-infective agents (e.g., ciprofloxacin, levofloxacin, ofloxacin), which also have been used with success in the treatment of travelers' diarrhea, may be considered first. The precise role of co-trimoxazole in the management of Wegener's granulomatosis and the drug's effect on long-term morbidity and mortality remain to be determined, but the drug appears to be a useful alternative to more toxic drugs (e.g., cyclophosphamide) in some patients.Co-trimoxazole is used in the treatment of Whipple's disease caused by Co-trimoxazole is administered orally or by IV infusion.
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