Trimethoprim/Sulfamethoxazole (Bactrim, Septra) (IV, PO) [PEDS]

Adjustment of Dose & Administration

Indication-Specific Adjustment

TREATMENT

Indication (TREATMENT)	Dose Recommended (IV/PO)
	CrCl (mL/min/1.73 m2) or dialysis type
	> 30	15 - 30	<15, HD
PJP	5 mg/kg/dose every 6-8 hours	Consider 50% decrease in total daily dose	Consider 50-75% decrease in total daily dose
Bloodstream infection	5 mg/kg/dose every 12 hours
Skin and soft tissue infection	4-6 mg/kg/dose every 12 hours
Urinary tract infection	4 mg/kg/dose every 12 hours

*mg/kg dosing based on TMP component*

**Maximum dose is 160 mg TMP/dose. EXCEPTION: PJP treatment maximum dose is 320 mg TMP / dose

PROPHYLAXIS

• PJP: 2.5 mg TMP/kg/dose every 12 hours given 3x weekly on alternating or consecutive days (Maximum dose: 160 mg TMP / dose)

Drug-Specific Information

• Single strength tablet: 400 mg sulfamethoxazole/80 mg trimethoprim
• Double strength tablet: 800 mg sulfamethoxazole/160 mg trimethoprim
• Pediatric suspension: 200 mg sulfamethoxazole-40 mg trimethoprim/5 mL
• Injection: 80 mg sulfamethoxazole-16 mg trimethoprim/mL
  • IV Bactrim is not highly concentrated and may lead to accumulation of fluid. Use cautiously and monitor

General Notes

1. Up-to-date cost information, click here 
2. IV antimicrobials outpatient (OPAT) dosing, click here
3. Obesity dosing weight recommendations here
4. Helpful drug-drug interaction check website here 
5. When dosing guidance is provided it is important to note the following:

Fixed (ie non weight-based) doses in adults are historically based on a 70 kg patient. Specific disease states or individual patients may warrant dosages that differ from the above recommendations. Since product-specific criteria for dose adjustment based on creatinine clearance exist, consult product information regarding specific recommendations for dosage adjustment based on estimated creatinine clearance.