Abstract
Co-trimoxazole is a combination drug of trimethoprim (TMP) and sulfamethoxazole (SMX) in a 1: 5 ratio. This combination interferes with two consecutive steps in the normal bacterial metabolism of folinic acid. All sulfonamides competitively inhibit the utilization of p-aminobenzoic acid (pABA) in the synthesis of dihydrofolic acid. Since humans do not synthesize dihydrofolic acid but depend on dietary sources for their needs, this inhibition occurs only in the microorganism. TMP blocks the conversion of dihydrofolic acid to tetrahydrofolic acid (folinic acid) by inactivating the enzyme dihydrofolate reductase. This reaction occurs both in humans and in microorganisms, but the enzyme system of the microorganism is 10,000–50,000 times more sensitive than the corresponding mammalian system (Chap 1). The synergistic, bactericidal effect of the combination TMP/SMX has been demonstrated (Böhni 1969; Darell et al. 1968; Dornbusch 1971; Schwartz and Rieder 1970) in a wide variety of gram-positive and gram-negative organisms. The effect is maximal at a TMP/SMX ratio between 1: 5 and 1:40, depending on the parasite involved (see also Chap. 4).
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Andreasen F, Elsborg L, Husted S, Thomsen O (1978) Pharmacokinetics of sulfadiazine and trimethoprim in man. Eur J Clin Pharmacol 14: 57–67
Ardati KO, Thirumoorthi MC, Dajani AS (1979) Intravenous trimethoprim-sulfamethoxazole in the treatment of serious infections in children. J Pediatr 95: 801–806
Bach MC, Gold O, Finland M (1973) Absorption and urinary excretion of trimethoprim, sulfamethoxazole, and trimethoprim-sulfamethoxazole: results with single doses in normal young adults and preliminary observations during therapy with trimethoprim-sulfamethoxazole. J Infect Dis [Suppl] 128: 584–598
Baethke R, Golde G, Gahl G (1972) Sulphamethoxazole/trimethoprim: pharmacokinetic studies in patients with chronic renal failure. Eur J Clin Pharmacol 4: 233–240
Beck H (1971) Etude pharmacocinetique des constituants du bactrim. Rev Med Liege 23: 1437
Bergan T, Brodwall EK (1972a) Human pharmacokinetics of a sulfamethoxazole-trimethoprim combination. Acta Med Scand 192: 483–492
Bergan T, Brodwall EK (1972b) Kidney transport in man of sulfamethoxazole and trimethoprim. Chemotherapy 17: 320–333
Bergan T, Vik-Mo H, Anstad U (1977) Kinetics of a sulfadiazine-trimethoprim combination. Clin Pharmacol Ther 22: 211–224
Bergmann M, Lederer B, Takacs (1979) Zur Bestimmung der Gewebskonzentration von Sulfametrol-Trimethoprim in der menschlichen Prostata. Urologe [A]18:335–337
Böhni E (1969) Vergleichende bakteriologische Untersuchungen mit Kombination Trimethoprim/Sulfamethoxazol in vitro and in vivo. Chemotherapy [Suppl] 14: 1–21
Boger WP, Gavin JJ (1960) Sulfamethoxazole: comparison with sulfisoxazole and sulfacthidole and cerebrospinal fluid diffusion. Antibiot Chemother 10: 572
Bänger P, Diller W, Führ J, Krüger-Thimer E (1961) Vergleichende Untersuchungen an neueren Sulfanilamiden. Arzneim Frosch 11: 247–255
Büttner H, Portwich F, Manzke E, Staudt N (1964) Zur Pharmakokinetic von Sulfonamiden unter pathologischen Bedingungen. Klin Wochenschr 42: 103–108
Burchall JJ (1969) Discussion on interaction between trimothoprim and methotrexate. Postgrad Med J [Suppl] 45: 51
Bushby SRM, Bushby MB (1976) Trimethoprim/sulfamethoxazole synergy and prostatis. In: Williams JD, Geddes AM (eds) Proc 9th Congr Chemother, London. Plenum, New York, pp 383–388
Bushby SRM, Hitchings GH (1968) Trimethoprim, a sulphonamide potentiator. Br J Pharmacol Chemother 33: 72–90
Chisholm D, Waterworth PM, Calnan JS, Garrod LP (1973) Concentration of antibacterial agents in interstitial tissue fluid. Br Med J 1: 569–573
Christensen LK, Hansen JM, Kristensen M (1963) Sulphaphenazole-induced hypoglycaemic attacks in tolbutamide-treated diabetics. Lancet 11: 1298–1301
Craig WA, Kunin CM (1973) Trimethoprim-sulfamethoxazole: pharmacodynamic effects of urinary pH and impaired renal function. Ann Intern Med 78: 491–497
Craven JL, Pugsley DJ, Blowers R (1970) Trimethoprim-sulphametoxazole in acute osteomyelitis due to penicillin-resistant staphylococci in Uganda. Br Med J 111: 201–203
Dabhoiwala NF, Bye A, Claridge M (1976) A study of concentrations of trimethoprim-sulphamethoxazole in the human prostate gland. Br J Urol 48: 77–81
Darell JH, Garrod LP, Waterworth PM (1968) Trimethoprim: laboratory and clinical studies. J Clin Pathol 21: 202–209
Donike M, Lücker PW, Simon B (1977) Klinisch-pharmakologische Untersuchungen zur Pharmakokinetik einer Trimethoprim/Sulfamethoxazol-Zubereitung an gesunden Versuchspersonen. Arzneim Forsch 27: 2373–2377
Dornbusch K (1971) Regression line analysis of the synergistic effect for the combination of trimethoprim/sulphamethoxazole. Chemotherapy 16: 229–238
Eatman FB, Maggio AC, Pocelinko R et al. (1977) Blood and salivary concentrations of sulfamethoxazole and trimethoprim in man. J Pharmacokinet Biopharm 5: 615–624
Farid Z, Girgis NI, Yassin W, Edman DC, Miner WF (1976) Trimethoprim-sulfamethoxazole and bacterial meningitis. Ann Intern Med 84: 50–51
Fowle ASE (1973) Aspect of the pharmacokinetic behaviour of trimethoprim and sulphamethoxazole. In: Bernstein LS, Salter AJ (eds) Trimethoprim/sulphamethoxazole in bacterial infections. Churchill Livingstone London, pp 63–72
Fowle ASE, Bye A (1972) Concentration of trimethoprim and sulphamethoxazole in human prostate fluid. Adv Antimicrob Antineoplast Chemother I/2: 1289–1290
Fowle ASE, Bye A, Hariri F, Middlemiss D, Naficy K (1975) The dosage of Co-trimoxazole in childhood. Eur J Clin Pharmacol 8: 217–222
Friedrich H, Hänsel G (1977) Liquorspiegel-Untersuchungen einer Trimethoprim-Sulfamethoxazol-Kombination im Ventrikelliquor bei neurochirurgischen Patienten. Acta Neurochir (Wien) 37: 271–280
Fries N, Keuth U, Braun JS (1975) Untersuchungen zur Liquorgängigkeit von Trimethoprim im Kindesalter. Fortschr Med 93: 1178–1183
Gnarpe H, Friberg J (1976) The penetration of trimethoprim into seminal fluid and serum. Scan J Infect Dis [Suppl] 8: 50–52
Grose WE, Bodey GP, Ti Li Loo (1979) Clinical pharmacology of intravenously administered trimethoprim-sulfamethoxazole. Antimicrob Agents Chemother 15: 447–451
Hall PW (1961) Renal secretory Tm for sulfonamide. Clin Res 9: 248
Hansen I, Nielsen ML, Bertelsen S (1973a) Trimethoprim in human saliva, bronchial secretion and lung tissue. Acta Pharmacol Toxicol (Copenh) 32: 337–344
Hansen I, Nielsen ML, Heerfordt L, Henriksen B, Bertelsen S (1973b) Trimethoprim in normal and pathological human lung tissue. Chemotherapy 19: 221–234
Hansen I, Nielsen ML, Nielsen JB (1975) A new method for homogenization of bone exemplified by measurement of trimethoprim in human bone tissue. Acta Pharmacol Toxicol (Copenh) 37: 33–42
Hansen JM, Siersbaek-Nielsen K, Skovsted L, Kampmann JP, Lumholtz B (1975) Potentiation of warfarin by Co-trimoxazole. Br Med J 11: 684
Hassall C, Feetan CL, Leach RH, Meynell MJ (1975) Potentation of warfarin by Cotrimoxazole. Lancet I1: 1155–1156
Hitzenberger G, Korn A, Kotzaurek R, Schmidt P, Deutsch E (1971) Pharmakokinetik von Trimethoprim und Sulfamethoxazol bei Patienten mit schwerster renaler Eliminationsstörung und Haemodialyse. In: Renal elimination of drugs. V III. Symp Nephrol Assoc, Aachen
Hughes DTD, Bye A, Hodder P (1972) Levels of trimethoprim and sulphamethoxazole in blood and sputum in relation to treatment of chest infections. Adv Antimicrob Antineoplast Chemother 1 /2: 1105–1106
Kaplan SA, Weinfeld RE, Cotter S, Abruzzo CW, Alexander K (1970) Pharmacokinetic profile of trimethoprim in dog and man. J Pharm Sci 59: 358–363
Kaplan SA, Weinfeld RE, Abruzzo CW, MacFaden K, Jack ML, Weissman L (1973) Pharmacokinetic profile of trimethoprim-sulfamethoxazole in man. J Infect Dis [Suppl] 128: 547–555
Kaufmann S, Hennes R (1973) Klinische Erfahrungen und pharmakokinetische Untersuchungen mit Bactrim „Roche“ bei Meningitis. Med Welt 24: 1903–1906
Klapp F, Baldauf G, Braun JS, Poeplau P, Hertel P (1973) Nachweis von Trimethoprim in gesundem und entzündetem Knochengewebe. Med Welt 24: 944–945
Koch UJ, Schumann KP, Kuchler R, Kewitz H (1973) Efficacy of trimethoprim sulfamethoxazole and the combination of both in acute urinary tract infection. Chemotherapy 19: 314–321
Korn A, Hitzenberger G, Jaschek I (1972) Pharmacokinetics of the combination of trimethoprim with sulfamethoxazol. Adv Antimicrob Antineoplast Chemother 1 /1: 2124
Kremers P, Duvivier J, Heusghem C (1974) Pharmacokinetic studies of co-trimoxazole in man after single and repeated doses. J Clin Pharmacol 14: 112–117
Kremers P, Claessens H, Heusghem C (1975) Comparative pharmacokinetics in man of parenterally and orally administered CO-trimoxazole. Medikon 4: 19–21
Kuhne J, Kohlmann FW, Seydel JK, Wempe E (1976) Pharmakokinetic der Kombination Sulfamoxol/Trimethoprim (CN 3123) bei Tier und Mensch. Arzneim Forsch 26: 651–657
Lafaix C, Pechere JC, Zarouf M, Neto JPA, Rey M (1972) The therapeutic of septic meningitis with sulfamethoxazole-trimethoprime. Adv Antimicrob Antineoplast Chemother 1 /2: 1227–1229
Liedtke R, Haase W (1979) Steady-state pharmacokinetics of sulfamethoxazole and trimethoprim in man after rectal application. Arzneim Forsch 29: 345–349
Lumholtz B, Siersbaek-Nielsen K, Skovsted L, Kampmann JP, Hansen JM (1975) Sulphamethizole-induced inhibition of dephenylhydantoin, tolbutamide, and warfarin metabolism. Clin Pharmacol Ther 17: 731–734
Männistö P, Tuomisto J, Saris N-E, Lehtinen T (1973) Pharmacokinetic studies with trimethoprim and different doses of sulfadiazine in healthy human subjects. Chemotherapy 19: 289–298
Malmborg A, Dornbusch K, Eliasson R, Lindholmer C (1976) Concentration of antibacterials in human seminal plasma. In: Williams JD, Geddes AM (eds) Proc 9th Congr Chemother, London. Plenum, New York, pp 53–59
McAllister TA (1974) Treatment of osteomyelitis. Br J Hosp Med 12: 535–545
Miller RD, Salter AJ (1973) The passage of trimethoprim/sulphamethoxazole into breast milk and its significance. Proc 8th Congr Chemother, Athens, Vol 1, pp 687–691
Morzaria RN, Walton IE, Pickering D (1969) Neonatal meningitis treated with trimethoprim and sulfamethoxazole. Br Med J 11: 511
Neuman M, Kazmierczak A, Charbonnier A (1972) Etat fonctionnel du foie et pouvoir antibactérien de l’association triméthoprime-sulfaméthazole dans le sang, la bile et les urines chez l’homme. Therapie 27: 1069–1080
Nielsen ML, Hansen I (1972) Trimethoprim in human prostatic tissue and prostatic fluid. Scand J Urol Nephrol 6: 244–248
Nolte H, Büttner H (1973) Pharmacokinetics of trimethoprim and its combination with sulfamethoxazole in man after single and chronic oral administration. Chemotherapy 18: 274–284
Nolte H, Büttner H (1974) Investigations on plasma levels of sulfamethoxazole in man after single and chronic oral administration alone and in combination with trimethoprim. Chemotherapy 20: 321–330
Ohnhaus EE, Spring P (1975) Elimination kinetics of sulfadiazine in patients with normal and impaired renal function. J Pharmacokinet Biopharm 3: 171–179
Oosterlinck W, Defoort R, Renders G (1976) The concentration of sulphamethoxazole and trimethoprim in human prostate gland. Chemotherapy 6: 389–393
Pohjanpelto PEJ, Sarmela TJ, Raines T (1974) Penetration of trimethoprim and sulphamethoxazole into the aqueous humour. Br J Ophthalmol 58: 606–608
Pullin C, Bye A, Fowle ASE (1972) The distribution of trimethoprim in total body water. Adv Antimicrob Antineoplast Chemother 1 /1: 25–26
Quayle AA, Hailey DM (1973) Antimicrobial substances in saliva: sulphamethoxazole and trimethoprim ( CO-trimoxazole ). Br J Oral Surg 1: 60–65
Reber H, Wild F, Paris J (1963) Experimentelle Daten über das neue Sulfonamid 5-Methyl- 3-sulfanilamido-isoxazol (Ro 4–2130) beim Erwachsenen. Chemotherapia 6: 273–284
Reid DWJ, Caille G, Kaufmann NR (1975) Maternal and transplancental kinetics of trimethoprim and sulfamethoxazole, separately, and in combination. Can Med Assoc J 112: 67–72
Rieder J (1963) Physikalisch-chemische und biologische Untersuchungen an Sulfonamiden. Arzneim Forsch 13: 81–88
Rieder J (1973) Metabolism and techniques for assay of trimethoprim and sulfamethox-azole. J Infect Dis [Suppl] 128: 567–573
Rieder J, Schwartz DE (1975) Pharmakokinetik der Wirkstoffkombination Trimthoprim + Sulfamethoxazol bei Leberkranken im Vergleich zu Gesunden. Arzneim Forsch 25: 656–666
Rieder J, Ellerhorst B, Schwartz DE (1974a) Übergang von Sulfamethoxazol und Trimethoprim in das Augenkammerwasser beim Menschen. Graefes Arch Ophthalmol 190: 51–61
Rieder J, Schwartz DE, Zangaglia O (1974b) Passage of sulfamethoxazole and trimethoprim into the bile in man. Chemotherapy 20: 65–81
Rieder J, Schwartz DE, Fernex M et al. (1974c) Pharmacokinetics of the antibacterial combination sulfamethoxazole plus trimethoprim in patients with normal or impaired kidney function. Antibiot Chemother 18: 148–198
Roy LP (1971) Sulphamethoxazole-trimethoprim in infancy. Med J Aust 1: 148–149
Sabel KG, Brandberg A (1975) Treatment of meningitis and septicemia in infancy with a sulphamethoxazole/trimethoprim combination. Acta Paediatr Scand 64: 25–32
Salmon JD, Fowle ASE, Bye A (1975) Concentrations of trimethoprim and sulphamethoxazole in aqueous humour and plasma from regimes of CO-trimoxazole in man. J Antimicrob Chemother 1: 205–211
Schiffman DO (1975) Evaluation of an anti-infective combination. JAMA 231: 635–637
Schwartz DE, Rieder J (1970) Pharmacokinetics of sulfamethoxazole + trimethoprim in man and their distribution in the rat. Chemotherapy 15: 337–355
Schwartz DE, Zeigler WH (1969) Assay and pharmacokinetics of trimethoprim in man and animals. Postgrad Med J 45: 32–37
Schwartz DE, Koechlin BA, Weinfeld RE (1969) Spectrofluorimetric method for the determination of trimethoprin in body fluids. Chemotherapy [Suppl] 14: 22–29
Schwartz DE, Vetter W, Englert G (1970) Trimethoprim metabolites in rat, dog and man: qualitative and quantitative studies. Arzneim Forsch 20: 1867–1871
Sharpstone P (1969) The renal handling of trimethoprim and sulphamethoxazole in man. Postgrad Med J [Suppl] 45: 38–42
Sharpstone P, Pickard J, Williams R (1972) Concentrations of trimethoprim and sulphamethoxazole in human bile. Proc 7th Congr Chemother, Prague. Adv Antimicrob Antineoplast Chemother 1 /2: 1269–1971
Sigel CW, Grace ME, Nichol CA (1973) Metabolism of trimethoprim in man and measurement of a new metabolite: a new fluorescence assay. J Infect Dis [Suppl] 128: 580–583
Stamey TA, Condy M (1975) The diffusion and concentration of trimethoprim in human vaginal fluid. J Infect Dis 131: 261–266
Stamey TA, Meares EM, Winningham DG (1970) Chronic bacterial prostatitis and the diffusion of drugs into prostatic fluid. J Urol 103: 187–194
Toscano F, Paschetta G (1972) Distribution of the sulfamethoxazole-trimethorpin combination in cerebro-spinal fluid. G Mal Infett Parassit 24: 585
Vree TB, Hekster YA, Baars AM, Damsma JE, van der Kleijn E (1978) Pharmacokinetics of sulphamethoxazole in man: Effects of urinary pH and urine flow on metabolism and renal excretion of sulphamethoxazole and its metabolite N4-acetylsulphamethoxazole. Clin Pharmacokinet 3: 319–329
Welling PG, Craig WA, Amidon GL, Kunin CM (1973) Pharmacokinetics of trimethoprim and sulfamethoxazole in normal subjects and in patients with renal failure. J Infect Dis [Suppl] 128: 556–566
Winningham DG, Nemoy NJ, Stamey TA (1968) Diffusion of antibiotics from plasma into prostatic fluid. Nature 219: 139–143
Ylikorkala O, Sjöstedt E, Järvinen PA, Tikkanen R, Raines T (1973) Trimethoprim-sulfonamide combination administered orally and intravaginally in the first trimester of pregnancy: its absorption into serum and transfer to amniotic fluid. Acta Obstet Gynecol Scand 52: 229–234
Yoshikawa TT, Guze LB (1976) Concentrations of trimethoprim-sulfamethoxazole in blood after a single, large oral dose. Antimicrob Agents Chemother 10: 462–463
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1983 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Hansen, I. (1983). Clinical Pharmacokinetics of Co-trimoxazole. In: Hitchings, G.H. (eds) Inhibition of Folate Metabolism in Chemotherapy. Handbook of Experimental Pharmacology, vol 64. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-81890-5_11
Download citation
DOI: https://doi.org/10.1007/978-3-642-81890-5_11
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-81892-9
Online ISBN: 978-3-642-81890-5
eBook Packages: Springer Book Archive