Your Own Health.
member of the National Association of Hospital and Administrative
Pharmacists of Nigeria, Ejionye Oluchi, discusses co-trimoxazole better
known as septrin with MOTUNRAYO JOEL
call it is an antibiotic or specifically antibacterial formulation
composed of two active constituents or drugs. The first is a sulfonamide
antibiotic, sulfamethoxazole (SMZ), and the other is trimethoprim
(TMP); sometimes abbreviated as SMZ-TMP. Both drugs belong to the class
of antibiotics called antifolates. They are so called because they
prevent the synthesis or utilisation of folic acid by the bacterial
cell. They do this by inhibiting the enzymes in the bacteria that carry
out such actions.
human and bacteria cells to produce some chemicals needed for DNA
synthesis, which is the building block of our genetic makeup. Every
living, developing or growing cell or organism needs an effective
genetic functioning. That is why folic acid is a most for pregnant
women. If the genetic functioning is prevented by blocking folic acid
utilisation, the organism simply stops growing and ultimately dies.
folic acid, they synthesis their own. Hence, co-trimoxazole has much
more effect on bacteria than on human cells. Simultaneous utilisation of
the two drugs, SMZ-TMP, gives a good synergistic effect than when
either drug is used independently.
formulation and so is used to treat bacterial infections caused by
susceptible organisms. Such infections include urinary tract infections,
respiratory tract infections like infected bronchitis, pneumonia,
infections in cystic fibrosis, otitis media and intra-abdominal
infections such as typhoid fever.
susceptible to the drug. The right thing to do when you have any of
such infections is to consult a clinician who will prescribe a microbial
culture and sensitivity (MCS) test to ascertain what organism is
responsible for the infection and to which antibiotic it is sensitive
before prescribing such drug; though empirical treatment may commence
while awaiting the test result.
been found to boost the immunity of HIV/AIDS patients, thereby improving
their resistance to infections. The exact mechanism of this effect is
not well known but the drug has become part of the routine therapy for
such patients. Nevertheless, such use must be under the supervision of
the attending clinician since the drug may interact with some
because the drug is often misused. People use septrin as a routine cough
regimen. Whenever parents or their wards manifest any symptom of cough,
they quickly run to a “chemist” shop to pick either the tablet or
suspension of septrin. This is a bad practice and has serious public
matter of fact any other antibiotic, may create enormous economic and
health burden. Development of resistant strains of bacteria to these
readily available and very affordable drugs is not an issue to be taken
lightly. As we many know, resistant strains of bacteria has already
started developing. Many infection cases are no longer responding to
conventional treatment. The implication is that it is going to take huge
investment of scarce resources in research, uncertain length of time
with persistent hard-to-treat infections and much more, to develop
alternatives to these cheap and available products. Such drugs will
never be as affordable and available as septrin and other ones.
variety of etiology. Cough may be due to allergic response, viral
infection, mucus/fluid accumulation in the lungs/air ways, reaction to
drugs and bacterial infections. When one has persistent cough after
taking routine OTC demulcent, expectorant mucolytic cough preparation,
visit your doctor or health professional for further diagnosis and
proper treatment. Do not be in a haste to buy co-trimoxazole.
and most of the side effects may not come through anyway. However, I
will mention some of the important side effects.
cause liver problems and kidney problems especially if not taken with
enough water or in a dehydrated or renal impaired patient as the drug
can crystallise and accumulate in the kidneys. Other important adverse
effects of septrin are hypersensitivity or allergic reactions which
include rash, toxic epidermal necrosis, systematic lupus erythematosis
and Stevens-Johnson syndrome. Although these reactions are rare, they
usually have devastating effects when they occur. If you notice any form
of rash or blister formation while or after taking this drug, please
stop the drug immediately and report to the nearest health centre or
facility near you. Co-trimoxazole can also cause some form of blood
disorders especially in patients with already existing blood cell
problems, ( for example sickle cell patients and those with G6PD
that may result in accumulation of the drug in the body (pharmacokinetic
reactions), and thereby cause more adverse effects that may inhibit or
potentiate the effect of the drug, (pharmacodynamic reactions). It is
the responsibility of your pharmacist and doctor to inform you and
possibly make some adjustments in your regimen. Tell your doctor or
pharmacist if you are taking any of the following class of drugs as they
may interact with septrin: drugs for rheumatism, anticancer drugs,
drugs for hypertension, drugs for diabetes, drugs for epilepsy, drugs
for HIV, drugs that affect blood clothing, and fansidar (sulfadoxin
+/pyrimethamine) which is an antimalarial drug.
infections, the term “substitute” is used carefully. Antibacterial
therapy is all about susceptibility and safety. Substitution, if
co-trimoxazole is contraindicated, will depend on a lot of factors,
including the state of the patient, (for example pregnant, breast
feeding, liver failure and kidney failure), bacteria species causing the
infection and its sensitivity to test result, site of infection, (for
example respiratory tract, urinary tract and intra-abdominal, central
in selecting a potential “substitute” for any medication. There are no
hard and fast rules.
except under strict supervision of a doctor. As stated earlier, folic
acid is a highly essential vitamin needed by a pregnant woman for
neuronal development of the feotus and overall cell division and growth.
Deficiency or malfunction of folic acid metabolism can lead to some
teratogenic or other congenital abnormalities especially within the
first trimester, (first 3 months of pregnancy). Co-trimoxazole is an
antifolate and interferes with the body’s use of folic acid. It can also
cause some blood related problems to the unborn baby when used within
the last three months of pregnancy. This drug is better avoided during
pregnancy or used under strict surveillance.
sickle cell anaemia should also not take septrin. Other conditions where
the drug should be avoided or used with extra caution are: patients
with renal impairment; patients with liver disorders; patients already
sensitive to the drug (i.e. those that has reacted to it before), or to
any other sulfurnamide such as some diuretics (drugs that make you
urinate more), fansidar, some anti-diabetic drugs such as glibenclamide
(also known as Daonil); and infants under six weeks.
stomach that is one hour before food or at least two hours after food.
This is because food reduces the absorption of the drug from the
stomach. Secondly, take septrin with at least a glass of water and
plenty of water thereafter, and as long as the treatment goes. This is
because the drug and its waste products are cleared or removed from the
body through the kidney. These can easily crystalise within the kidney
when there is reduced body fluid, especially if the urine is acidic.
This can lead to serious kidney problems and later kidney failure.
Finally, observe for signs of hypersensitivity reaction such as rash,
blister formations, sore throat, difficulty breathing or swallowing
fever, feeling like fainting. If you notice any of these, please stop
the drug and call for medical attention.