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sulfamethoxazole-trimethoprim

sulfamethoxazole-trimethoprim
Brand names: Bactrim, Septra
Form Strength
SOLUTION, INTRAVENOUS 80 mg-16 mg/mL
TABLET, ORAL 800 mg-160 mg (DS tab)
Display Sulfonamides Class: 081220
Medication comments:

Per policy, these drugs are subject to renal dosing adjustments by pharmacy. 
Generic + Route
(Brand)
• Indications		 Usual Adult Dose
Comments		 Renal Dosage Adjustments
sulfamethoxazole-trimethoprim IV
(Bactrim/Septra©)		 8-20 mg/kg/day
(TMP component)
divided q6-12h
Actual body weight		 CrCl > 30: No adjustment necessary
CrCl 15-30: Reduce to 50% of usual dose
CrCl < 15/HD/PD: Reduce to 25-50% of usual dose
sulfamethoxazole-trimethoprim PO
(Bactrim/Septra©)		 1-2 DS tablets q12-24h CrCl > 30: No adjustment necessary
CrCl 15-30: Reduce to 50% of usual dose
CrCl < 15/HD/PD: Reduce to 25-50% of usual dose or 3x/week
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication: trimethoprim-sulfamethoxazole (Bactrim, Septra)
Criteria 3: Potentially inappropriate medications: drugs to be used with caution in older adults. (Table 4)
Drug(s) trimethoprim-sulfamethoxazole
Rationale Increased risk of hyperkalemia when used concurrently with an ACEI, ARB, or ARNI in presence of decreased CrCl.
Recommendation Use with caution in patients on ACEI, ARB, or ARNI and decreased CrCl.
 Quality of evidence: Low, Strength of Recommendation: Strong
 
Criteria 5: medications that should be avoided or have their dosage reduced with varying levels of kidney function in older adults. (Table 6)
CrCl (mL/min) at which action is required <30
Rationale Increased risk of worsening of kidney function and hyperkalemia; risk of hyperkalemia especially prominent with concurrent use of an ACE, ARB, or ARNI.
Recommendation Reduce dosage if CrCl is 15-29 mL/min.
Avoid if CrCl <15 mL/min.
 Quality of evidence: Moderate, Strength of Recommendation: Strong
Pediatric Pharmacy Association 2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics 
Medication: sulfamethoxazole-trimethoprim (Bactrim, Septra)
Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List: Second Edition (Table 1)
Drug sulfonamides
Risk/Rationale Kernicterus
Recommendation Caution in younger than 1 mo
 Quality of evidence: Very low, Strength of Recommendation: Weak
Last updated: Sep. 25, 2025
  • Renal Adjustment Policy sulfamethoxazole-trimethoprim subject to adjustments by pharmacy.
UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556



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