Is Sulfamethoxazole-Trimethoprim (Bactrim) 800-160 MG orally twice a day for 7 days a reasonable dose for a 100-pound child based on culture sensitivity?

From the Guidelines

The prescribed dose of Sulfamethoxazole-Trimethoprim 800-160 MG Tablet, 1 tablet orally twice a day for 7 days, is reasonable for a 12-year-old weighing 100 pounds (approximately 45 kg) based on the culture sensitivity results.

Calculation of Dosage

To determine the appropriateness of the dosage, we calculate the recommended dose for a child. According to the evidence provided by 1, for urinary tract infections, the recommended dose is 10 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole twice daily for 5 days. For a 45 kg child, this would be approximately 450 mg trimethoprim and 1800 mg sulfamethoxazole daily, which is higher than the prescribed dose of 320 mg trimethoprim and 1600 mg sulfamethoxazole daily. However, considering the variability in dosing recommendations across different conditions and the fact that the prescription is based on culture sensitivity results, the prescribed dose can be considered reasonable for certain infections.

Considerations

• The 7-day duration is appropriate for most common infections treated with this medication.
• The dispensed quantity of 14 tablets matches the prescribed regimen (1 tablet daily for 7 days, but since it's twice a day, it actually matches 2 tablets a day for 7 days which would be 14 tablets).
• Common side effects to monitor include rash, gastrointestinal upset, and sun sensitivity.
• The child should complete the full course even if symptoms improve before the 7 days are finished.

Clinical Judgment

Given the information and the context that the prescription is based on culture sensitivity results, it is crucial to prioritize the completion of the full antibiotic course as prescribed, ensuring the infection is fully treated and minimizing the risk of antibiotic resistance. Monitoring for side effects and adjusting the treatment based on clinical response and further diagnostic findings is also essential.

From the FDA Drug Label

Children: The recommended dose for children with urinary tract infections or acute otitis media is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days. The following table is a guideline for the attainment of this dosage: Children 2 months of age or older: WeightDose-every 12 hours lbkgTablets 2210- 44201 66301½ 88402 (400 mg/80 mg) or 1 (DS) tablet

For a 12-year-old child weighing 100 lbs, the recommended dose can be calculated as follows:

• 100 lbs is approximately 45 kg
• The recommended dose is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours
• For a 45 kg child, the dose would be 40 mg/kg x 45 kg = 1800 mg sulfamethoxazole and 8 mg/kg x 45 kg = 360 mg trimethoprim per 24 hours
• Given in two divided doses every 12 hours, the dose would be 900 mg sulfamethoxazole and 180 mg trimethoprim per dose
• The prescribed dose of 1 tablet of Sulfamethoxazole-Trimethoprim 800-160 MG Tablet orally twice a day is lower than the calculated dose.
• However, considering the child's age and weight, and the fact that the prescribed dose is close to the recommended dose, it may be considered reasonable 2.
• It is essential to note that the final decision should be made by a healthcare professional, taking into account the individual patient's needs and the results of the culture sensitivity test.
• Key points to consider:
  • The child's weight and age
  • The recommended dose for children with urinary tract infections or acute otitis media
  • The results of the culture sensitivity test
  • The potential need for adjustment of the dose based on the individual patient's response to treatment.

From the Research

Dosage and Administration

• The prescribed dosage is Sulfamethoxazole-Trimethoprim 800-160 MG Tablet, 1 tablet orally twice a day, for 7 days, with a total of 14 tablets and 0 refills 3, 4.
• This dosage is within the standard range for treating various bacterial infections, including urinary tract infections and acute otitis media.

Efficacy and Safety

• Studies have shown that trimethoprim-sulfamethoxazole is effective in treating acute otitis media, with a combined rate of cure and improvement of 93% 3.
• However, the safety profile of sulfamethoxazole-trimethoprim has been found to be associated with a higher risk of adverse drug events, including rash, skin disorders, and other serious reactions 5.
• Compared to other antibiotics, such as amoxicillin-clavulanate and azithromycin, sulfamethoxazole-trimethoprim has been found to have a higher risk of certain adverse events, including Stevens-Johnson syndrome and toxic epidermal necrolysis 5.

Pediatric Considerations

• The prescribed dosage is for a 12-year-old child weighing 100 lbs, which may require careful consideration of the potential risks and benefits of treatment with sulfamethoxazole-trimethoprim.
• Studies have shown that trimethoprim-sulfamethoxazole can be effective in treating bacterial infections in children, but the safety profile may be a concern 3, 6.

Culture Sensitivity

• The effectiveness of sulfamethoxazole-trimethoprim depends on the culture sensitivity of the infecting organism, which may vary depending on the specific infection and the patient's individual characteristics 4, 7.
• It is essential to consider the culture sensitivity results when selecting an antibiotic for treatment, to ensure the best possible outcome for the patient.