Trimethoprim-Sulfamethoxazole
Renal - Adult

Renal - Adult

Usual Dose 1-2 DS tabs Q12h

CrCl 15-30 mL/min

Reduce daily dose to 50% of usual dose

CrCl < 15 mL/min or Dialysis

Reduce daily dose to 25-50% of usual dose

Stenotrophomonas infections, Toxoplasmosis, and other bacterial infections

CrCl > 30 mL/min

No dose adjustment

CrCl 15-30 mL/min

5 mg/kg IV/PO Q24h

CrCl < 15 mL/min not on HD

2.5 mg/kg IV/PO Q24h

Dialysis

5 mg/kg IV/PO Q24h, give post-HD on HD days

CVVHD

5 mg/kg IV/PO Q8-12h

For flow rates > 3L/hr, contact ID pharmacy

Pneumocystis pneumonia

CrCl > 30 mL/min

No dose adjustment

CrCl 15-30 mL/min

2.5 mg/kg IV/PO Q8h

CrCl < 15 mL/min not on HD

5 mg/kg IV/PO Q24h

Dialysis

5 mg/kg IV/PO Q24h

Give post-HD on HD days

CVVHD

5 mg/kg IV/PO Q8h

For flow rates > 3L/hr, contact ID pharmacy

Notes

  • Each DS tab = TMP 160 mg-SMX 800 mg
  • Each SS tab = TMP 80 mg-SMX 400 mg
  • For obese patients, use AdjBW for weight-based doses
  • Highly bioavailable, switch IV to PO when stable or taking orals
  • For IV, monitor volume status as each IV dose is diluted in 250-500 mL D5W