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Antimicrobials > Trimethoprim > Flashcards

Trimethoprim Flashcards

1
Q

What is the MOA of trimethoprim?

A

Bacteriostatic; competitively inhibits bacterial FOLATE production essential for bacterial growth

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2
Q

What is the indications for trimethoprim use?

A
  1. Empirical treatment of uncomplicated lower UTIs
  2. Epididymo-orchitis (urinary tract source)
  3. Prostatitis (acute or chronic)
  4. Mild-to-moderate PCP, with dapsone (second line)
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3
Q

What is epididymo-orchitis?

A

Epididymo-orchitis is inflammation of the epididymis, and occasionally the testis.

The epididymis is a long, coiled tube that stores sperm and transports it from the testes

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4
Q

What is prostatitis?

A

Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.

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5
Q

What are the precautions for the use of trimethoprim?

A
  1. Drugs that cause potassium retention, eg ACE inhibitors - increase risk of hyperkalaemia; monitor potassium concentration
  2. Blood
  3. Renal
  4. Pregnancy
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6
Q

What is the renal precaution surrounding the use of trimethoprim?

A

Contraindicated if CrCL <10mL/minute; reduce dose if CrCl 10-30mL/minute

Impairment increase risk of hyperkalaemia; trimethoprim may increase serum creatinine concentration (reversible).

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7
Q

What is the blood precaution surrounding the use of trimethoprim?

A

Contraindicated in megaloblastic anaemia due to folate deficiency

Folate deficiency may worsen, increasing risk of blood dyscrasias; consider using folinic acid supplement. Blood dyscrasias may worsen.

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8
Q

What is the elderly precaution surrounding the use of trimethoprim?

A

Prone to nutritional folate deficiency; may be more susceptible to adverse effects, eg hyperkalaemia.

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9
Q

Is trimethoprim safe to use in pregnancy and breastfeeding?

A

Avoid in first trimester of pregnancy, as trimethoprim has been associated with congenital anomalies and an increases risk of miscarriage.
It is unlikely to pose a risk in second or third trimester.

Safe to use in breastfeeding.

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10
Q

What are the common adverse effects of trimethoprim?

A 
Fever
Itch 
Rash 
Nausea
Vomiting
Hyperkalaemia
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11
Q

What are the rare adverse effects of trimethoprim?

A

Hyponatreamia
ALlergy
Leucopenia, thrombocytopenia, megaloblastic anaemia

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12
Q

What is the average onset of hyperkalaemia and the risk factors associated with trimethoprim?

A

Trimethoprim causes potassium retention. Hyperkalaemia can occur with usual doses but is more likely to be clinically significant as dose increases.
Average onset is 4-5 days.
Risk factors: high dose and renal impairment.

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13
Q

What is the trimethoprim treatment dose for acute, uncomplicated UTI?

A

Women, oral 300mg at night for 3 days

Men, oral 300mg at night for 7 days

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14
Q

What is the trimethoprim treatment dose for recurrent UTI?

A

Oral, 300mg at night for 10-14 days

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15
Q

What is the trimethoprim treatment dose for prophylaxis UTI?

A

Oral, 150mg at night

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16
Q

What is the trimethoprim treatment dose for prostatitis?

A

Oral, 300mg at night for 4 weeks

17
Q

What is the trimethoprim treatment dose for epididymo-orchitis?

A

Oral, 300mg once daily for 2 weeks

18
Q

What is the trimethoprim treatment dose for mild-moderate PCP?

A

Oral 5mg/kg tds, with dapsone, for 21 days

19
Q

What is the treatment dose of trimethoprim if a patient has renal impairment?

A

CrCl 15–30 mL/minute, usual dose for 3 days, then halve dose.

CrCl 10–15 mL/minute, halve dose.

20
Q

What monitoring does trimethoprim require?

A
  • monitor complete blood count and folate status during prolonged or high-dose treatment
  • monitor serum potassium, beginning on day 3, if the patient has renal impairment, is taking drugs that can cause hyperkalaemia, or is taking a high dose, eg to treat PCP
21
Q

When is the best time to administer trimethoprim?

A

•give at night to maximise urinary concentration for UTI

22
Q

Is single dose treatment effective for uncomplicated lower UTI in women?

A

•single-dose treatment for uncomplicated lower UTI in women may be considered; however, treatment for 3 days is more effective in preventing relapse

Antimicrobials (8 decks)

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