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Cotrimoxazole prophylaxis
Cotrimoxazole (trimethoprim-sulfamethoxazole) is a fixed-dose combination antibiotic that inhibits bacterial folate synthesis, preventing DNA replication in susceptible microorganisms.
Cotrimoxazole (trimethoprim-sulfamethoxazole) is a fixed-dose combination antibiotic that inhibits bacterial folate synthesis, preventing DNA replication in susceptible microorganisms. Used for Prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients, Prophylaxis of toxoplasmosis in HIV-positive patients with CD4 count <100 cells/μL, Prophylaxis of other opportunistic infections in immunocompromised populations.
At a glance
| Generic name | Cotrimoxazole prophylaxis |
|---|---|
| Also known as | CTX, Bacrtim (R), Trimethoprim-Sulfamethoxazole Combination |
| Sponsor | Institute of Tropical Medicine, Belgium |
| Drug class | Antibiotic combination (sulfonamide + diaminopyrimidine) |
| Target | Dihydrofolate reductase and dihydropteroate synthase |
| Modality | Small molecule |
| Therapeutic area | Infectious Disease |
| Phase | Phase 3 |
Mechanism of action
Trimethoprim inhibits dihydrofolate reductase while sulfamethoxazole inhibits dihydropteroate synthase, both enzymes critical for bacterial folate metabolism. This dual mechanism provides synergistic bactericidal activity against a broad spectrum of gram-positive and gram-negative bacteria, as well as certain parasites and fungi. Prophylactic use prevents opportunistic infections in immunocompromised patients.
Approved indications
- Prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in immunocompromised patients
- Prophylaxis of toxoplasmosis in HIV-positive patients with CD4 count <100 cells/μL
- Prophylaxis of other opportunistic infections in immunocompromised populations
Common side effects
- Rash
- Nausea
- Vomiting
- Diarrhea
- Hyperkalemia
- Hepatotoxicity
- Stevens-Johnson syndrome
Key clinical trials
- Prevent TB: Choice Architecture for TPT Delivery (NA)
- An Adaptive Multi-arm Trial to Improve Clinical Outcomes Among Children Recovering From Complicated SAM (PHASE3)
- Role of Prophylactic Postoperative Antibiotics in HoLEP (PHASE4)
- Study of Rezafungin Compared to Standard Antimicrobial Regimen for Prevention of Invasive Fungal Diseases in Adults Undergoing Allogeneic Blood and Marrow Transplantation (PHASE3)
- [18F]Fluoropropyl-Trimethoprim ([18F]F-TMP) PET/CT Imaging to Evaluate Biodistribution and Kinetics in Human Subjects (PHASE1)
- 11C-Trimethoprim PET/CT Imaging to Evaluate Biodistribution and Kinetics in Human Subjects (PHASE1)
- Safety and Efficacy of a Weekly Oral Cyclic Antibiotic Programme in the Prevention of Urinary Tract Infection on Neurological Bladder (PHASE4)
- Sulfamethoxazole Prophylaxis Duration After Renal Transplantation (NA)
Primary sources
Every claim on this page is sourced from regulatory or scientific primary sources. See our editorial policy for full methodology.
| Source | Used for |
|---|---|
| ClinicalTrials.gov | Trial enrolment, design, endpoints, results |