Septra DS Uses

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What is Septra DS?

Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) combination is used to treat infections such as urinary tract infections, middle ear infections (otitis media), bronchitis, traveler's diarrhea, and shigellosis (bacillary dysentery). Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) is also used to prevent or treat Pneumocystis jiroveci pneumonia or Pneumocystis carinii pneumonia (PCP), a very serious kind of pneumonia. This type of pneumonia occurs more commonly in patients whose immune systems are not working normally, such as cancer patients, transplant patients, and patients with acquired immune deficiency syndrome (AIDS).

Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) combination is an antibiotic. It works by eliminating the bacteria that cause many kinds of infections. Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) will not work for colds, flu, or other virus infections.

Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) is available only with your doctor's prescription.

Septra DS indications

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To reduce the development of drug-resistant bacteria and maintain the effectiveness of Septra DS and other antibacterial drugs, Septra DS should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Urinary Tract Infections:

For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris. It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination.

Acute Otitis Media:

For the treatment of acute otitis media in pediatric patients due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when, in the judgment of the physician, Septra DS offers some advantage over the use of other antimicrobial agents. To date, there is limited data on the safety of repeated use of Septra DS in pediatric patients under two years of age. Septra DS is not indicated for prophylactic or prolonged administration in otitis media at any age.

Acute Exacerbations of Chronic Bronchitis in Adults:

For the treatment of acute exacerbations of chronic bronchitis due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when, in the judgment of the physician, Septra DS offers some advantage over the use of a single antimicrobial agent.

Travelers' Diarrhea in Adults:

For the treatment of travelers' diarrhea due to susceptible strains of enterotoxigenic E. coli.

Shigellosis:

For the treatment of enteritis caused by susceptible strains of Shigella flexneri and Shigella sonnei when antibacterial therapy is indicated.

Pneumocystis Carinii Pneumonia:

For the treatment of documented Pneumocystis carinii pneumonia. For prophylaxis against Pneumocystis carinii pneumonia in individuals who are immunosuppressed and considered to be at an increased risk of developing Pneumocystis carinii pneumonia.

How should I use Septra DS?

Use Septra DS suspension as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Septra DS suspension.

Uses of Septra DS in details

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Use: Labeled Indications

Oral: Treatment of urinary tract infections (UTIs) due to

Escherichia coli, Klebsiella and Enterobacter spp, Morganella morganii, Proteus mirabilis, and Proteus vulgaris; acute otitis media; acute exacerbations of chronic obstructive pulmonary disease due to susceptible strains of Haemophilus influenzae or Streptococcus pneumoniae; treatment and prophylaxis of Pneumocystis pneumonia (PCP); traveler's diarrhea due to enterotoxigenic E. coli; treatment of shigellosis caused by Shigella flexneri or Shigella sonnei.

IV: Treatment of PCP; treatment of shigellosis caused by S. flexneri or S. sonnei; treatment of severe or complicated UTIs due to E. coli, Klebsiella and Enterobacter spp, M. morganii, P. mirabilis, and P. vulgaris.

Off Label Uses

Bite wound infection, prophylaxis or treatment (animal or human bite)

Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTI), Septra DS, in combination with an appropriate agent for anaerobic coverage, is an effective and recommended alternative for the prophylaxis and treatment of animal bite wounds.

Clinical experience suggests the utility of Septra DS as an alternative agent for the prophylaxis and treatment of human bite wounds.

Toxoplasma gondii encephalitis (prophylaxis/treatment/chronic maintenance) in HIV-infected patients

Based on the US Department of Health and Human Services (HHS) guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents, Septra DS is an effective and recommended agent for primary prophylaxis of Toxoplasma gondii encephalitis and is an effective and recommended alternative agent for the treatment of or as chronic maintenance therapy of T. gondii encephalitis in HIV-infected patients.

Septra DS description

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A pyrimidine inhibitor of dihydrofolate reductase, it is an antibacterial related to pyrimethamine. The interference with folic acid metabolism may cause a depression of hematopoiesis. It is potentiated by sulfonamides and the Trimethoprim (Septra DS DS)-Sulfamethoxazole (Septra DS DS) combination is the form most often used. It is sometimes used alone as an antimalarial. Trimethoprim (Septra DS DS) resistance has been reported.

Septra DS dosage

Septra DS Dosage

Generic name: Trimethoprim (Septra DS DS) 80mg, Sulfamethoxazole (Septra DS DS) 400mg

Dosage form: tablet

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Contraindicated in pediatric patients less than 2 months of age.

Urinary Tract Infections and Shigellosis in Adults and Pediatric Patients and Acute Otitis Media in Pediatric Patients:

Adults: The usual adult dosage in the treatment of urinary tract infections is one Septra DS DS (double strength) tablet, two Septra DS tablets, or four teaspoonfuls (20 mL) Septra DS Suspension every 12 hours for 10 to 14 days. An identical daily dosage is used for 5 days in the treatment of shigellosis.

Pediatric Patients: The recommended dose for pediatric patients with urinary tract infections or acute otitis media is 8 mg/kg Trimethoprim (Septra DS DS) and 40 mg/kg Sulfamethoxazole (Septra DS DS) per 24 hours, given in two divided doses every 12 hours for 10 days. An identical daily dosage is used for 5 days in the treatment of shigellosis. The following table is a guideline for the attainment of this

Dosage:

Pediatric Patients: Two Months of Age or Older
Weight Dose-Every 12 Hours
lb kg Teaspoonfuls Tablets
22 10 1 (5 mL)
44 20 2 (10 mL) 1
66 30 3 (15 mL) 1 1/2
88 40 4 (20 mL) 2 (or 1 DS Tablet)

For Patients With Impaired Renal Function: When renal function is impaired, a reduced dosage should be employed using the following table:

Creatinine Recommended
Clearance Dosage
(mL/min) Regimen
Above 30 Use Standard Regimen
15-30 1/2 the Usual Regimen
Below 15 Use Not Recommended

Acute Exacerbations of Chronic Bronchitis in Adults:

The usual adult dosage in the treatment of acute exacerbations of chronic bronchitis is one Septra DS DS (double strength) tablet, two Septra DS tablets, or four teaspoonfuls (20 mL) Septra DS Suspension every 12 hours for 14 days.

Travelers' Diarrhea in Adults:

For the treatment of travelers' diarrhea, the usual adult dosage is one Septra DS DS (double strength) tablet, two Septra DS tablets, or four teaspoonfuls (20 mL) of Septra DS Suspension every 12 hours for 5 days.

Pneumocystis Carinii Pneumonia:

Treatment:

Adults and Pediatric Patients: The recommended dosage for treatment of patients with documented Pneumocystis carinii pneumonia is 15 to 20 mg/kg Trimethoprim (Septra DS DS) and 75 to 100 mg/kg Sulfamethoxazole (Septra DS DS) per 24 hours given in equally divided doses every 6 hours for 14 to 21 days. The following table is a guideline for the upper limit of this

Dosage:

Weight Dose – Every 6 Hours
lb kg Teaspoonfuls Tablets
18 8 1 (5 mL)
35 16 2 (10 mL) 1
53 24 3 (15 mL) 1 1⁄2
70 32 4 (20 mL) 2 (or 1 DS Tablet)
88 40 5 (25 mL) 2 1⁄2
106 48 6 (30 mL) 3 (or 1 1⁄2 DS Tablets)
141 64 8 (40 mL) 4 (or 2 DS Tablets)
176 80 10 (50 mL) 5 (or 2 1⁄2 DS Tablets)

For the lower limit dose (15 mg/kg Trimethoprim (Septra DS DS) and 75 mg/kg Sulfamethoxazole (Septra DS DS) per 24 hours) administer 75% of the dose in the above table.

Prophylaxis:

Adults: The recommended dosage for prophylaxis in adults is one Septra DS DS (double strength) tablet daily.

Pediatric Patients: For pediatric patients, the recommended dose is 150 mg/m2/day Trimethoprim (Septra DS DS) with 750 mg/m2/day Sulfamethoxazole (Septra DS DS) given orally in equally divided doses twice a day, on 3 consecutive days per week. The total daily dose should not exceed 320 mg Trimethoprim (Septra DS DS) and 1,600 mg Sulfamethoxazole (Septra DS DS). The following table is a guideline for the attainment of this dosage in pediatric patients:

Body Surface Area Dose–every 12 hours
(m2) Teaspoonfuls Tablets
0.26 1⁄2 (2.5 mL)
0.53 1 (5 mL) 1⁄2
1.06 2 (10 mL) 1

More about Septra DS (Sulfamethoxazole (Septra DS DS) / Trimethoprim (Septra DS DS))

Consumer resources

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Other formulations

Related treatment guides

Septra DS interactions

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What other drugs will affect Septra DS?

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Potential for Septra DS to Affect Other Drugs

Trimethoprim (Septra DS DS) is an inhibitor of CYP2C8 as well as OCT2 transporter. Sulfamethoxazole (Septra DS DS) is an inhibitor of CYP2C9. Caution is recommended when Septra DS is co-administered with drugs that are substrates of CYP2C8 and 2C9 or OCT2.

In elderly patients concurrently receiving certain diuretics, primarily thiazides, an increased incidence of thrombocytopenia with purpura has been reported.

It has been reported that Septra DS may prolong the prothrombin time in patients who are receiving the anticoagulant warfarin (a CYP2C9 substrate). This interaction should be kept in mind when Septra DS is given to patients already on anticoagulant therapy, and the coagulation time should be reassessed.

Septra DS may inhibit the hepatic metabolism of phenytoin (a CYP2C9 substrate). Septra DS, given at a common clinical dosage, increased the phenytoin half-life by 39% and decreased the phenytoin metabolic clearance rate by 27%. When administering these drugs concurrently, one should be alert for possible excessive phenytoin effect.

Sulfonamides can also displace methotrexate from plasma protein binding sites and can compete with the renal transport of methotrexate, thus increasing free methotrexate concentrations.

There have been reports of marked but reversible nephrotoxicity with coadministration of Septra DS and cyclosporine in renal transplant recipients.

Increased digoxin blood levels can occur with concomitant Septra DS therapy, especially in elderly patients. Serum digoxin levels should be monitored.

Increased Sulfamethoxazole (Septra DS DS) blood levels may occur in patients who are also receiving indomethacin.

Occasional reports suggest that patients receiving pyrimethamine as malaria prophylaxis in doses exceeding 25 mg weekly may develop megaloblastic anemia if Septra DS is prescribed.

The efficacy of tricyclic antidepressants can decrease when coadministered with Septra DS.

Septra DS potentiates the effect of oral hypoglycemics that are metabolized by CYP2C8 (e.g., pioglitazone, repaglinide, and rosiglitazone) or CYP2C9 (e.g., glipizide and glyburide) or eliminated renally via OCT2 (e.g., metformin). Additional monitoring of blood glucose may be warranted.

In the literature, a single case of toxic delirium has been reported after concomitant intake of Septra DS and amantadine (an OCT2 substrate). Cases of interactions with other OCT2 substrates, memantine and metformin, have also been reported.

In the literature, three cases of hyperkalemia in elderly patients have been reported after concomitant intake of Septra DS and an angiotensin converting enzyme inhibitor.

Drug/Laboratory Test Interactions

Septra DS, specifically the Trimethoprim (Septra DS DS) component, can interfere with a serum methotrexate assay as determined by the competitive binding protein technique (CBPA) when a bacterial dihydrofolate reductase is used as the binding protein. No interference occurs, however, if methotrexate is measured by a radioimmunoassay (RIA).

The presence of Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) may also interfere with the Jaffé alkaline picrate reaction assay for creatinine, resulting in overestimations of about 10% in the range of normal values.

Septra DS side effects

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What are the possible side effects of Septra DS?

The most common adverse effects are gastrointestinal disturbances (nausea, vomiting, anorexia) and allergic skin reactions (such as rash and urticaria). FATALITIES ASSOCIATED WITH THE ADMINISTRATION OF SULFONAMIDES, ALTHOUGH RARE, HAVE OCCURRED DUE TO SEVERE REACTIONS, INCLUDING STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, FULMINANT HEPATIC NECROSIS, AGRANULOCYTOSIS, APLASTIC ANEMIA, OTHER BLOOD DYSCRASIAS, AND HYPERSENSITIVITY OF THE RESPIRATORY TRACT.

Hematologic:

Agranulocytosis, aplastic anemia, thrombocytopenia, leukopenia, neutropenia, hemolytic anemia, megaloblastic anemia, hypoprothrombinemia, methemoglobinemia, eosinophilia.

Allergic:

Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, allergic myocarditis, erythema multiforme, exfoliative dermatitis, angioedema, drug fever, chills, Henoch- Schönlein purpura, serum sickness-like syndrome, generalized allergic reactions, generalized skin eruptions, photosensitivity, conjunctival and scleral injection, pruritus, urticaria, and rash. In addition, periarteritis nodosa and systemic lupus erythematosus have been reported.

Gastrointestinal:

Hepatitis, including cholestatic jaundice and hepatic necrosis, elevation of serum transaminase and bilirubin, pseudo-membranous enterocolitis, pancreatitis, stomatitis, glossitis, nausea, emesis, abdominal pain, diarrhea, anorexia.

Genitourinary:

Renal failure, interstitial nephritis, BUN and serum creatinine elevation, toxic nephrosis with oliguria and anuria, and crystalluria.

Metabolic:

Hyperkalemia, hyponatremia.

Neurologic:

Aseptic meningitis, convulsions, peripheral neuritis, ataxia, vertigo, tinnitus, headache.

Psychiatric:

Hallucinations, depression, apathy, nervousness.

Endocrine:

The sulfonamides bear certain chemical similarities to some goitrogens, diuretics (acetazolamide and the thiazides), and oral hypoglycemic agents. Cross-sensitivity may exist with these agents. Diuresis and hypoglycemia have occurred rarely in patients receiving sulfonamides.

Musculoskeletal:

Arthralgia and myalgia. Isolated cases of rhabdomyolosis have been reported with Septra DS, mainly in AIDS patients.

Respiratory System:

Cough, shortness of breath, and pulmonary infiltrates.

Miscellaneous:

Weakness, fatigue, insomnia.

Septra DS contraindications

See also:
What is the most important information I should know about Septra DS?

Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) is contraindicated in patients with a known hypersensitivity to Trimethoprim (Septra DS DS), USP or sulfonamides, in patients with a history of drug-induced immune thrombocytopenia with use of Trimethoprim (Septra DS DS), USP and/or sulfonamides, and in patients with documented megaloblastic anemia due to folate deficiency.

Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) is contraindicated in pediatric patients less than 2 months of age. Sulfamethoxazole (Septra DS DS) and Trimethoprim (Septra DS DS) is also contraindicated in patients with marked hepatic damage or with severe renal insufficiency when renal function status cannot be monitored.

Active ingredient matches for Septra DS:

Sulfamethoxazole/trimethoprim


Unit description / dosage (Manufacturer)Price, USD
Tablet; Oral; Sulfamethoxazole 800 mg; Trimethoprim 160 mg
Tablets; Oral; Sulfamethoxazole 800 mg; Trimethoprim 160 mg

List of Septra DS substitutes (brand and generic names):

SEPTRAN Capsule/ Tablet / 100mg - 20mg / 10 units (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.02
SEPTRAN Capsule/ Tablet / 400mg - 80mg / 10 units (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.08
SEPTRAN Liquid / 200mg - 40mg per 5ml / 50ml units (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.13
Septran Sulfamethooxazole400mg, Trimethoprim 80mg TAB / 10 (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.07
Septran Sulfamethooxazole100mg, Trimethoprim 40mg P-TAB / 10 (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.03
Septran Sulfamethooxazole200mg, Trimethoprim 40mg/5ml P-SUSP / 50ml (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.14
10's (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.03
50ml (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.14
Suspension; Oral; Sulfamethoxazole 200 mg; Trimethoprim 40 mg / 5 ml (Glaxo Smithkline Pharmaceuticals Ltd.)
Tablets; Oral; Sulfamethoxazole 100 mg; Trimethoprim 20 mg (Glaxo Smithkline Pharmaceuticals Ltd.)
Tablets; Oral; Sulfamethoxazole 400 mg; Trimethoprim 80 mg (Glaxo Smithkline Pharmaceuticals Ltd.)
Septran 100+20 Tablet (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.00
Septran 50 ml Suspension (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.01
Septran 100 ml Syrup (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.01
Septran 80+400 Tablet (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.01
Septran Sulfamethooxazole400mg, Trimethoprim 80mg TAB / 10 (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.07
Septran Sulfamethooxazole100mg, Trimethoprim 40mg P-TAB / 10 (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.03
Septran Sulfamethooxazole200mg, Trimethoprim 40mg/5ml P-SUSP / 50ml (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.14
SEPTRAN ADULT 400 MG/80 MG TABLET 1 strip / 10 tablets each (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.08
SEPTRAN DS 800MG/160MG TABLET 1 strip / 10 tablets each (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.09
SEPTRAN PEAD 100 MG/20 MG TABLET 1 strip / 10 tablets each (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.03
SEPTRAN PEAD 200 MG/40 MG SUSPENSION 1 bottle / 50 ML suspension each (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.18
SEPTRAN tab 10's (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.08
SEPTRAN P- tab 10's (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.03
SEPTRAN P- oral susp 50ml (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.16
Septran Adult 400 mg/80 mg Tablet (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.01
Septran DS 800mg/160mg Tablet (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.01
Septran Pead 100 mg/20 mg Tablet (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.00
Septran Pead 200 mg/40 mg Suspension (Glaxo Smithkline Pharmaceuticals Ltd.)$ 0.18
Injectable; Injection; Sulfamethoxazole 400 mg; Trimethoprim 80 mg / 5 ml (Aspen)
Suspension; Oral; Sulfamethoxazole 200 mg; Trimethoprim 40 mg / 5 ml (Aspen)
Tablet; Oral; Sulfamethoxazole 400 mg; Trimethoprim 80 mg (Aspen)
Septrin 1 Bottle 50 mL (Aspen)
Septrin 1's (Aspen)
Septrin 900 mL x 1's (Aspen)$ 52.86
Septrin 100's (Aspen)$ 44.80
Septrin 200's (Aspen)$ 49.78
Septrin 30 mL (Aspen)$ 1.80
Septrin 70 mL (Aspen)$ 2.49
Tablets; Oral; Sulfamethoxazole 400 mg; Trimethoprim 80 mg (Aspen)
Septrin 50 mL x 1's (Aspen)$ 8.18
Septrin oral susp 30 mL x 1's (Aspen)$ 1.97
Septrin oral susp 70 mL x 1's (Aspen)$ 2.72
Suspension; Oral; Sulfamethoxazole 400 mg; Trimethoprim 80 mg / 5 ml
Tablet; Oral; Sulfamethoxazole 400 mg; Trimethoprim 80 mg
Tablets; Oral; Sulfamethoxazole 400 mg; Trimethoprim 80 mg
Tablet; Oral; Sulfamethoxazole 800 mg; Trimethoprim 160 mg
Tablets; Oral; Sulfamethoxazole 800 mg; Trimethoprim 160 mg
Tablet; Oral; Sulfamethoxazole 800 mg; Trimethoprim 160 mg
Tablets; Oral; Sulfamethoxazole 800 mg; Trimethoprim 160 mg
Suspension; Oral; Sulfamethoxazole 400 mg; Trimethoprim 80 mg / 5 ml

References

  1. DailyMed. "SULFAMETHOXAZOLE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. DailyMed. "POLYMYXIN B SULFATE; TRIMETHOPRIM SULFATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  3. PubChem. "trimethoprim". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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