Classification

Cotrim® is the trade name of the antibiotic cotrimoxazole, which is viewed as a non-group antibiotic. It is characteristic that co-trimoxazole only exists in a fixed drug combination. This includes trimethoprim and sulfamethoxazole. Bactrim and Eusaprim should be mentioned as trade names for the individual preparations. The ratio in which both drugs are connected is always 1: 5.

effect

Either Sulfamethoxazole, as well as trimethoprim have an inhibitory effect on bacterial growth. The reason is the inhibition of the synthesis of bacterial folic acid. While sulfomethoxazole inhibits the enzyme dihydrofolate synthetase, trimethoprim works on the enzyme dihydrofolate reductase. In combination, both substances have a bactericidal effect (bactericidal).

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Areas of application

Cotrim® has a broad spectrum of activity and covers both gram-positive and gram-negative pathogens. The cocci and gram-negative rods that cover Cotrim® include: Neisseria, Enterobacteriaceae, streptococci and staphylococci. Cotrim® is ineffective against Pseudomonas, Bacteroides, Clostridia and spirochetes.

Acute and chronic urinary tract infections, acute and chronic inflammation of the urinary tract can be particularly good Nasal sinuses (Sinusitis) and bronchitis as well as the diseases typhoid and paratyphoid are treated. In intestinal diseases caused by pathogens, such as dysentery, cholera and salmonella and at lung infection Due to the pathogen Pneumocystis carinii, Cotrim® is also used.

Side effects

Cotrim® has all the side effects that sulfonamides have. The following should be mentioned here: complaints of the gastrointestinal tract, allergic reactions such as skin sensitization, fever, blood formation disorders, rare skin reactions (Lyell syndrome or Stevens-Johnson syndrome).

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Risk of crystallization in the kidney and the resulting kidney damage. In premature babies and newborns there is a risk of increased bilirubin levels (bilirubinemia) with accompanying yellowing of the eyes and skin (jaundice). A build-up of bile acids is also observed at times (cholestasis).

Please also read our article on this Antibiotic side effects

Interactions

Simultaneous administration of blood thinning medication (anticoagulants) and medication for the treatment of diabetes mellitus (oral antidiabetic agents, sulfonylureas), ciclospoprin A, phenytoin and thiopental can lead to an increase in the effectiveness of the substances listed. Simultaneous administration of non-steroidal anti-inflammatory drugs (e.g. ASA 100), salicylates, probenecid (indomethacin, phenylbutazone and sulfinpyrazone) can lead to a reduced breakdown of Cotrim® with a resulting increase in the concentration of the substance. Simultaneous administration of acid inhibitors (antacids) can reduce the effectiveness of Cotrim®. The parallel intake of the substance groups barbiturates, primidone and p-aminosalicylic acid can lead to an increased toxicity of Cotrim®.

The combination of Cotrim® and a dehydrating drug from the thiazide group of substances can lead to decreased blood platelets (thrombopenia).

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Cotrim and alcohol - are they compatible?

The consumption of alcohol should be avoided during therapy with co-trimoxazole. Alcohol is broken down into acetic acid in the liver with the help of two enzymes via the toxic acetaldehyde.

Some antibiotics - including co-trimoxazole - inhibit the enzyme that breaks down acetaldehyde into acetic acid. As a result, the intermediate product accumulates and manifests itself as nausea, vomiting, reddening of the skin, headache, dizziness and palpitations.

Acetaldehyde is also toxic to liver cells. Since cotrimoxazole has a half-life in the blood of about 10 hours and some effects of the drug may still be present afterwards, alcohol should be avoided for the first few days after discontinuation of cotrimoxazole.

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Cotrim and the pill - are they compatible?

Antibiotics can weaken the effects of the pill, so that there may be less protection against contraception. The most important ingredient in the pill, estrogen, is absorbed in the intestine and partly excreted by the liver.

Some bacteria change the chemical structure of the excreted estrogen so that it is reabsorbed in the intestines. This process is called enterohepatic circulation and is used to be able to safely prevent with a lower dose of estrogen.

However, if the bacteria are attacked by antibiotics, this cycle is disturbed and the pill may be less likely to be taken up again and thus less effective. The extent to which this increases the risk of unwanted pregnancy has not been conclusively proven by studies for many antibiotics.

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As a safety measure, mechanical contraception should also be used when taking cotrimoxazole, for example with condoms. The pill can be taken continuously and seven days after the last co-trimoxazole tablet has been taken, it can be assumed that the pill is fully effective again.

Cotrim forte

Cotrim forte is the trade name for tablets of the antibiotic cotrimoxazole with a dosage of 960mg. The drug is intended, among other things, for infections of the respiratory tract, kidney and urinary tract and the male and female genital organs.

As well as the selection of the antibiotic, it is also the task of the prescribing doctor to determine the dosage and method of ingestion. Guideline values ​​for the use of Cotrim forte are as follows: One tablet should be taken twice a day after meals in the morning and evening, for children under 13 years only half a tablet.

In most cases, the duration of use is about a week, although the use should be continued for 2-3 days after the symptoms have subsided. For uncomplicated urinary tract infections in women, a single dose of 3 tablets after a meal is recommended. The sexually transmitted disease gonorrhea (gonorrhea) can be treated with 5 tablets daily for up to three days.

To prevent infections of the urinary tract (e.g. cystitis), long-term therapy with one tablet per day can be prescribed for particularly vulnerable patients aged 13 and over. If the dose is forgotten, the medication should be taken normally at the next dose without doubling the dose. In the event of an overdose, symptoms such as vomiting, diarrhea, headache and dizziness can occur.

Cotrim for cystitis

Cotrim can be used to treat uncomplicated urinary tract infections in women, i.e. not only cystitis but also pelvic inflammation. Uncomplicated means that there is no impairment of kidney function, normal functional anatomy is present and there are no other factors that favor a urinary tract infection.

In principle, if there are no further complications, antibiotics can be dispensed with in the case of a cystitis and the spontaneous course can be waited for - the symptoms often disappear after about a week.

Cotrim is one of the first choice antibiotics, among other things because the one-time intake of 3 Cotrim forte tablets makes the therapy very straightforward. An alternative is the antibiotic nitrofurantoin, which must be taken for 5-7 days. The disadvantage of antibiotic therapy are the side effects of the medication, among other things, the body's own normal bacterial colonization is attacked.

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Is there Cotrim without a prescription?

Like other antibiotics, Cotrim is only available with a prescription. On the one hand, this is due to the fact that the drug can lead to serious side effects in some patients. On the other hand, if taken improperly, there is a risk of developing resistant bacteria that no longer respond well to antibiotics.

And last but not least, in the case of an infection that has to be treated with antibiotics, a doctor should always check that there are no complications that need further treatment, such as kidney failure in an ascending urinary tract infection.

Contraindications

Cotrim® should not be given if the blood disorder megaloblastic anemia was diagnosed or one allergy against sulfonamides is known in the patient.

In the pregnancy and Lactation should, if possible, dispensed with Cotrim® become. If it is used anyway, regular ultrasound monitoring of the development of the fetus is recommended.

Cotrim® should also not be given to premature and newborn babies. In severe kidney and liver disease and in the presence of the blood disease Glucose-6-phosphate dehydrogenase deficiency an alternative preparation should also be preferred.

Allergy to cotrim

Allergic reactions to Cotrim are relatively common.

Slight hypersensitivity reactions affect 1-10% of patients and usually manifest themselves in the form of skin symptoms such as rashes (e.g. with wheals, redness, spots, nodules or small spots such as measles), itching, small-spotted skin and mucous membrane bleeding, disease with education of red skin nodules and skin disease due to exposure to light.

Severe reactions occur in 1 to 10 out of 10,000 patients, among other things this can lead to severe skin inflammation with blistering and peeling of the skin. If an allergic reaction to Cotrim is known, an alternative antibiotic that does not belong to the Suflonamide class should be used.


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