What is the recommended dosage of Sulfatrim (trimethoprim/sulfamethoxazole) for a pediatric patient with a urinary tract infection (UTI)?

From the Guidelines

The recommended dosage of Sulfatrim (trimethoprim/sulfamethoxazole) for a pediatric patient with a urinary tract infection (UTI) is 6-12 mg/kg per day of trimethoprim and 30-60 mg/kg per day of sulfamethoxazole, divided into 2 doses. This dosage is based on the guidelines for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months, as outlined in the study published in Pediatrics in 2011 1.

Key Considerations

• The total course of therapy should be 7 to 14 days, with the option to switch from parenteral to oral administration once the patient exhibits clinical improvement and can retain orally administered fluids and medications.
• It is essential to know local patterns of susceptibility of coliforms to antimicrobial agents, particularly trimethoprim-sulfamethoxazole, to ensure effective treatment.
• The medication should be given with a full glass of water, and the suspension should be shaken well before measuring each dose.

Dosage Calculation

For example, a 20 kg child would receive approximately 120-240 mg of sulfamethoxazole and 12-24 mg of trimethoprim per dose, given twice a day.

Treatment Duration

The committee recommends a treatment duration of 7 to 14 days, with a minimum of 7 days, as evidence suggests that shorter courses are inferior for febrile UTIs 1.

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: Weight Dose-every 12 hours lb kg Tablets 22 10 - 44 20 1 66 30 1½ 88 40 2 or 1 DS tablet

The recommended dosage of Sulfatrim (trimethoprim/sulfamethoxazole) for a pediatric patient with a urinary tract infection (UTI) is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days 2.

• The dosage can be determined using the provided table as a guideline, based on the child's weight.
• For example, a child weighing 22-44 lb (10-20 kg) should receive 1 tablet every 12 hours.
• A child weighing 66 lb (30 kg) should receive 1½ tablets every 12 hours.
• A child weighing 88 lb (40 kg) should receive 2 tablets or 1 DS tablet every 12 hours.

From the Research

Sulfatrim Pediatric Dosage for UTI

The recommended dosage of Sulfatrim (trimethoprim/sulfamethoxazole) for pediatric patients with urinary tract infections (UTIs) can be determined based on the available evidence.

• The dosage of 12 mg/kg/day of trimethoprim-sulfamethoxazole for ten days has been used in clinical trials 3.
• However, the optimal dosage may vary depending on the specific patient population and the severity of the infection.
• A study published in 1970 used a dosage of 160 mg of TMP and 800 mg of SM administered orally twice daily for 10 days in adult patients with UTIs 4.
• For pediatric patients, a dosage of 12 mg/kg/day of trimethoprim-sulfamethoxazole has been used, with a mean serum concentration of 1.8 microgram/ml of trimethoprim and 62 microgram/ml of sulfamethoxazole one hour after the dose 3.
• Another study used a single dose of trimethoprim for the treatment of uncomplicated UTIs in children, with a dosage that was not specified 5.
• A study published in 1979 used a mixture of 40 mg of trimethoprim and 200 mg of sulfamethoxazole thrice weekly at bedtime for six months for the prophylaxis of recurrent UTIs in female patients, including six preadolescents who received one half this dose 6.
• The minimum effective dose of trimethoprim for UTI has been reported to be 100 mg in non-pregnant women 7.

Dosage Considerations

• The dosage of Sulfatrim for pediatric patients with UTIs should be individualized based on the patient's age, weight, and renal function.
• The dosage should be adjusted to achieve optimal serum concentrations of trimethoprim and sulfamethoxazole.
• The treatment duration should be based on the severity of the infection and the patient's response to therapy.
• Patients with underlying urological abnormalities may require longer treatment durations or more frequent follow-up appointments 3.