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Trimethoprim

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VOL: 101, ISSUE: 05, PAGE NO: 31

Generic/proprietary names

 

Generic/proprietary names
- Trimethoprim: Monotrim, Trimopan.

 

 

Action
- Trimethoprim prevents bacterial production by blocking the enzyme reduction of dihydrofolic acid.

 

 

- Is used in combination with sulfamethoxazole in co-trimoxazole because of synergistic activity but in this form it is associated with rare yet serious side-effects.

 

 

Classification
- Antibacterial.

 

 

- Folic acid inhibitor.

 

 

Indications
- Nurse prescriber: urinary tract infections in women.

 

 

- Other: acute and chronic respiratory tract infections, prostatitis, shigellosis and invasive salmonella infections.

 

 

Contraindications
- Allergy.

 

 

- Blood disease or disorders.

 

 

- Severe renal insufficiency.

 

 

Cautions
- Renal impairment.

 

 

- Folate deficiency.

 

 

- Older people.

 

 

- Neonates.

 

 

- Pregnancy and breastfeeding.

 

 

- Porphyria.

 

 

Common side-effects
- Nausea and vomiting/diarrhoea.

 

 

- Pruritus.

 

 

- Rash.

 

 

- Hyperkalaemia.

 

 

- Depression of haematopoiesis.

 

 

Rare side-effects
- Erythema multiforme.

 

 

- Toxic epidermal necrolysis.

 

 

- Aseptic meningitis.

 

 

- Allergic reactions.

 

 

- Angioedema.

 

 

- Anaphylaxis.

 

 

Interactions
- May increase action of antiepileptics, digoxin, antivirals, other antibacterials, anticoagulants and antiarrhythmic medications.

 

 

- An increased risk of haematological toxicity with some cytotoxic medication.

 

 

- An increased risk of nephrotoxicity with ciclosporin medication.

 

 

Administration
- Available in tablets or suspension.

 

 

- Usually given once or twice a day.

 

 

Nursing considerations
- Assess symptoms.

 

 

- Evaluate therapeutic response.

 

 

- Patients who are having long-term therapy need regular blood count assessment.

 

 

- In women of childbearing age enquire about last menstrual period.

 

 

Patient teaching
- Take trimethoprim on an empty stomach, one hour before or two hours after meals. Some patients may experience nausea. They can be advised to take trimethoprim with food.

 

 

- Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture.

 

 

- Discard any medication that is outdated or no longer needed.

 

 

- Be sure to complete the entire course of medication.

 

 

- Report any suspected side-effects to the health care professional who prescribed the medication.

 

 

- During breastfeeding traces of trimethoprim may be found in milk, but in short-term use this is not thought to be harmful.

 

 

- Women of childbearing age must be cautioned against becoming pregnant while taking trimethoprim, as there are teratogenic risks due to the folate-antagonist effects.

 

 

- Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.

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