TIEMPE/TRIMETHOPRIM

Adults:

Treatment of urinary tract infections and all other susceptible infections: 200 mg twice daily. Long term prophylaxis of recurrent urinary tract infections: 100 mg at night before bedtime. Children: 4 months to 12 years of age. Treatment of urinary tract infections and all other susceptible infections: 6mg/kg bodyweight daily, subdivided into 2 equal doses.

5mg/kg bodyweight daily given as a single dose before bedtime.

Elderly:

Treat as adults.

Advised dosage schedule where there is reduced kidney function:

Monitoring of renal function and serum electrolytes should be considered particularly with longer term use, in patients with impaired renal function. Trimethoprim should only be initiated and used in dialysis patients under close supervision from specialists in both infectious disease and renal medicine.

Trimethoprim is removed by dialysis. Monitoring trimethoprim plasma concentration may be considered with long term therapy but the value of this in individual cases should first be discussed with specialists in infectious disease and renal medicine.

Route of Administration:

Oral.

Skin and subcutaneous tissue disorders Not Known:

Drug reaction with eosinophilia and systemic symptoms (DRESS) Psychiatric disorders Very rare: Hallucinations Gastro-intestinal disturbances including nausea and vomiting, headache, skin rashes, pruritus and urticaria have been reported occasionally.

Hyperkalaemia and depression of haematopoiesis have also occurred. Erythema multiforme, toxic epidermal necrolysis, photosensitivity and other allergic reactions including angioedema and anaphylaxis have been reported rarely. Aseptic meningitis has also been reported.

Cases of Megaloblastic anaemia during prolonged therapy with Trimethoprim in doses higher than those recommended rarely occur but are reversible with discontinuation of therapy and administration of folinic acid.

8). Patients should be advised of the signs and symptoms and monitored closely for skin reactions. If signs and symptoms suggestive of these reactions appear, trimethoprim should be withdrawn immediately and an alternative treatment considered (as appropriate).

If the patient has developed a serious reaction such as SJS, TEN or DRESS with the use of trimethoprim, the treatment must not be restarted in this patient at any time. Patients with marked impairment of renal function; care should be taken to avoid accumulation and resulting adverse hepatological effects.

Monitoring of renal function and serum electrolytes should be considered particularly with longer term use. Trimethoprim should only be initiated and used in dialysis patients under close supervision from specialists in both infectious disease and renal medicine.

Regular haematological tests should be undertaken in patients receiving long- term treatment and those predisposed to folate deficiency. The elderly may be more susceptible to folate deficiency and a lower dose may be advisable. Patients and their carers should be told how to recognise signs of blood disorders and advised to seek immediate medical attention if symptoms such as fever, sore throat, rash, mouth ulcers, purpura, bruising or bleeding develop.

Particular care should be exercised in the haematological monitoring of children on long-term therapy. Porphyria. Elevations in serum potassium have been observed in some patients treated with trimethoprim. g. heparin). 5).

Severe hepatic insufficiency. Megaloblastic anaemia and other blood dyscrasias. Trimethoprim should not be administered to premature infants or children under 4 months of age. Pregnancy - Trimethoprim should not be administered to pregnant women.

6). eGFR (ml/min) Dosage advised Over 30 Normal 15- 30 Normal for 3 days then half dose Under 15 Half the normal dose