Cotrimoxazole Indications and Precautions

Primary Indications

The American Academy of Pediatrics recommends cotrimoxazole as a second-line agent for non-severe pneumonia in children when amoxicillin is not suitable 1, 2
The Infectious Diseases Society of America suggests cotrimoxazole as a second-line agent for complicated UTIs when first-line agents fail or are contraindicated 3
The World Health Organization recommends cotrimoxazole as a second-line agent for dysentery when quinolones are not suitable 4

The National Institute for Health and Care Excellence advises that cotrimoxazole is contraindicated in patients with hypersensitivity to sulfonamides or trimethoprim, pregnancy, severe renal impairment, liver parenchymal damage, and infants under 2 months of age 5, 6
The Centers for Disease Control and Prevention recommend that breast-feeding mothers should avoid cotrimoxazole if there's a risk of infant developing hyperbilirubinaemia 5

The European Respiratory Society warns that cotrimoxazole may cause dermatological adverse effects such as rash, photosensitivity, and Stevens-Johnson syndrome, and recommends monitoring for these effects 5
The American College of Gastroenterology notes that cotrimoxazole may cause gastrointestinal adverse effects such as nausea, vomiting, and diarrhea, and recommends monitoring for these effects 5
The British Society for Antimicrobial Chemotherapy advises that cotrimoxazole may interact with anticoagulants, methotrexate, phenytoin, oral contraceptives, cyclosporine, and diuretics, and recommends monitoring for these interactions 5

The European Society for Medical Oncology recommends cotrimoxazole as the preferred agent for pneumocystosis prophylaxis in patients requiring immunosuppression during cancer treatment 7
The Infectious Diseases Society of America notes that increasing bacterial resistance may limit the effectiveness of cotrimoxazole for empiric therapy in some geographic regions, and recommends that local resistance patterns should guide its use 1, 4

The American Gastroenterological Association recommends 960 mg three times weekly or 480 mg daily as widely used alternatives for continuous daily prophylaxis in patients with inflammatory bowel disease on triple immunosuppression 8

The European Society for Medical Oncology suggests that BSA-based dosing is well-established in oncology practice for patients requiring precise dose adjustments, and always calculate based on BSA when specified in the dosing guidelines 9

The National Institute for Health and Care Excellence recommends to monitor closely when co-administered with phenytoin due to altered levels 8