a ae 5 a * COTRIMOKAZOLE - Sulfamethoxazole + Trimethoprim = Cobrimo xa 20l& veloted HE antimalarial diaminopyrin dene > Trimethoprim iso ushich — Selectiveles inhibits pial dihydrotelate rag pyrimethamine Lacks 4 . reductase ( DHFRS). PABA (Para amine benzoic aud) Sul fonamucle 7 4 pict SE ee Eeee DHFA CBihyclroPolse acd) Dihydrofolate. reductase | THPA (Tebrahyclo folle acd) | Trim etho prin dimes more achive against bacterial > Trimethoprinn is 7 50,000 engyme Thus, humon DHER ose khan against the folate metabeltm — & nok interfered ok srammobiay eerkacteriol Concenbot wens oh rtmectheprion > Trdividually » beth Sulfonamide and cbimethhoprinn oe bacteriostalc, Combination becomes Ciel agers many Oreparens but the is Sensihre 3) Waximum Synergism = 5 Seen then the Orgenie™ to both =the Components but even. when ik ts moderodely veselant mation the other may be enhanced. fo one __ Component» Ahe neosly Same and -timethobrina ome Combining. 2 toot sulfamehorag ale Gclected for bey mtohy go, Sutfamedrerss™|® ah most — Orgonisms , wot in Care > aptimal — Synergism7 i the we al Sutfamelhovagole 29 Vimetbaprina 4 ts reduced by %-C-hma) oS Ws rabo is oblainedl "n plasma shen the tuo ole given’ iw ow dose) ratio SL, because’ Atyimmethoprin enters mayy testes» how. _Larger__volume of than salfamethorazol® — and aint Lower _ laren _ + However, the Concentraion raho 1m mmany bi cutageaenaa ; 2071 , carrer ond Placenton, > Trimethoprim — adequately Crosses Brod - brain Lhile —-Sulfamethoragcle hon poster embry + Moreover, -himetheprim rapidly absorbed thon cul fomethroraz a Gof rakes may = Very with = Ame. - > Trimethopam - 40°] a Plasma-protein bound Sulfamethorazole -— 65]. 2 Trimethoprim partly metabolised in ver and taereted in urine. Spec of Adtion- + Salmonella typhi + Sewato + Klebsiella - + Enterobacter + Yersinia enterocol bea. + preumoryshis JV rowed > ths Combination also aut. om SuMfonomitle -vestetant "Shain ob she F + Staph: aureus + stabh. pyogenes + shigelto + enteropathogenic E:celi + He influen rae + Gonocecei + eninge coe> Bacteria one Capable of orequiring resishance bo pram mediated acquis: bian chimethoprim mostly through inhibitor, of BWeRade having lower affrarty!__ for “the slow +e develop lee Ce eee Combused 4s cithey chug, alone, bak widestrenl & Se Gonliaudma ay a long | beried | Gee vesulled in reduced vesponsiveness over aes Grlginallay Sensitive shatas: | Adverse €Pfects- > AN adverse feels. Seen with «Sulfonamides Con be produced by Cobimoracole. * chncalls % Hanes’, Meadeche i ovhee — sack —anitestattene (painkal Sucllrns & sever inside fhe mouth) + Folate deficieney Cmegatoblarbe Anaemia) i¢ — iwhrequent, ecars Onty io ponents with marginal folate levels + Blood — dyscrasias occur rarely. > Cotrimoxazole should rot be given during preqrenty Trimethe prron, being on antfolote , there is theoretical teratogenic risk. Necinatel hoemotysis ond — methhoemoglbinnemia Can ecu if ik B give” near berm. devebop uremia. dase shoul renal —imbai rement. > patients with — renal disease mary be reduce in moclevatelag Severe = P.diroved when treated with hugh dose ca Cotrimoxagate - A (€ Alps) high Mnadene ok Cube sol of fever, rash on (A hone macro) hypeplani® hon been —_rehorted also ok | greater marrow risk ob Lowe eae OCCU sad toriity fem Cobimoxazole.Diuretics ghta” “with Cohimorazdd Ware — produerd higher Toeidence ee thrombocytopenia Base - 160mg 400mg fer smb -for im inf tahely CCIPLIN, OF TPR IM- it) cho Guy 5 how Injection (wk-TRIM , ORIPRIM- IV) “omg omg: per Smal for by tej ¢ 10-15ml BD. : of imnopoads, & Cotima zine - Trimethoprim + Sot fackiag Ceimilar wiley ee ~ au . z caoergs homgh f 8 Midget) 22° 4 qeie uses PRI wed HS. popularity iy the headmerd | fu Systemic infections has declined though Cobimoxazile is Common indications are A. Urinary Tract’ tafections - + Most acute uncomplicated infections reshond — rafptdly Acute Cyshiks - Single “dose therapy © WAabe of Cortimorazcle has been aged: Suctessfutly. - : : Nower ond Ubber UTI - 3 40 to days Course * Cotrimoxazole" is Shectatly’ Valuable for chronic. or recurrent Cases. or ie prostatitis , "becouse — hiwiethoprnn i piConcentrated tn! prostate, 2- Respiratory Tract Anfections - Both Upper and lower veshiratory frack | including chronic bronchitts and focie- marillay infectious , otitis medio Caused by gram positive Cocei and He influenzae —vesbond wel : % Becletal Diawhocos ond Dysentery. E Coli Shigella Co-timoragole i ~Aimoragole is Non-typhoid Salmonella Used ¥- Enterocolitica > Though —vecbonse rate is ower than previously, ond Plusroquinolones ane — Gommonly used, tt is SHI & Valuable allernative Ror embirteal ctherohy ch inkective diarrhoear a TT ST | + Preumocystis’ Jitaveci- which Causes Severe preumonia— 'euhopenic and Alps — patienls. obi : bet Colvimavasole hea prophylactic as well as “therapeubie Value + high doses ave needed EOS tah - 4-G-Hmes[day for 2-3 wks — may be Curative, but Adverse effects meegrcilate ditcontinuation upto 101. Cases OME D6 Hob - daily - prephylacbre use- well tolerated S Chancisid - Cotrimorazole C00 +160mg) GO - tu days ~ arc chorce , Allemattre 40.0 Ceftviaxéne » Belbvemyon or Ciprofloxacin 6 i ; i - Typhoid - Iniktatly — Cobimoragole was an effective alternative Chlovambphenicat. However, it has become unvelrable and is) Seldom: used vows F Ghimmtaaels ban altesnatic ~ te. fenicillin For ckething Sgremtocytosis patients ond fore: treating — resbiratory | gy other inlectors in them, Thtensive parental - Cofrimeragole’ theraby. has; been ; Used Suecgesfully i in. Septicacintae } but other drugs are mere’ Commonly -embloyecl row |