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Timethoprim Sulfamethoxazole inhibits the conversion of para amino benzoic acid (PABA) to dihydrofolate (DHFA) by inhibiting folate synthetase enzyme. Trimethoprim inhibits bacterial dihydrofolate reductase and blocks the conversion of dihydrofolate (DHFA) to tetra hydro folate (THFA). Thus Bactrim causes a sequential block of folate metabolism in bacteria.

The common side effects reported with Bactrim are nausea, vomiting, anorexia, rash and urticaria, agranulocytosis, aplastic anemia, thrombocytopenia, hepatitis, elevation of serum transaminase and bilirubin, renal failure, interstitial nephritis, toxic nephrosis with oliguria and anuria, hyperkalemia, convulsions, peripheral neuritis, cough, shortness of breath and pulmonary infiltrates, weakness, fatigue and insomnia.

Bactrim is not recommended in infants below the age of 2 months. Bactrim should be used with caution in patients who are taking thiazide diuretics as it can increase the incidence of thrombocytopenia with purpura. The combination of Sulfamethoxazole and Trimethoprim should be used carefully along with anticoagulant warfarin as it can prolong the prothrombin time. The serum digoxin levels should be monitored when given along with Bactrim. Bactrim should be given with caution in patients with renal or hepatic dysfunction, folate deficiency or bronchial asthma. Bactrim potentiates the effect of oral hypoglycemics in diabetic patients. Bactrim should not be administered in pregnant woman and nursing mothers as sulfamethoxazole and trimethoprim interfere with folic acid metabolism.

The recommended starting dosage of Bactrim in adults for urinary tract infection and acute exacerbations of chronic bronchitis is 2 Bactrim tablets every 12 hours for 10 to 14 days. The recommended dose for children with urinary tract infections is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim given in two divided doses every 12 hours for 10 days. The recommended dosage for patients Pneumocystis carinii pneumonia is 75 to 100 mg/kg sulfamethoxazole and 15 to 20 mg/kg trimethoprim given in equally divided doses every 6 hours for 14 to 21 days. The recommended dose of Bactrim in traveller€™s diarrhea is 2 Bactrim tablets every 12 hours for 5 days.