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Pharmacology

Infections

Question 41 of 180

Regarding trimethoprim, which of the following statements is INCORRECT:

Answer:

The dose of trimethoprim should be reduced in severe renal impairment as the drug is predominantly excreted by the kidney.

Trimethoprim

Pharmacology / Infections

Last Updated: 26th March 2019

Mechanism of Action

Trimethoprim inhibits bacterial metabolism. It is well absorbed orally and is effective in most patients with simple lower urinary tract infections.

A combination of trimethoprim and sulfamethoxazole (co-trimoxazole) may produce a synergistic action and increased activity against certain bacteria. Co-trimoxazole has an important use in the treatment of Pneumocystis jiroveci pneumonia.

Contraindications

Trimethoprim is contraindicated in blood dyscrasias and should be used with caution in the elderly and neonates as it predisposes to folate deficiency. The risk of folate deficiency is also increased when trimethoprim is combined with certain drugs e.g. methotrexate.

There is a teratogenic risk in first trimester (folate antagonist) and manufacturers advise to avoid during pregnancy. However the NICE CKS guidelines state that trimethoprim can be used during pregnancy (although it should not be used first-line when other alternatives are available); if trimethoprim is used during the first trimester, it should be co-prescribed with folic acid 5 mg daily.

The dose should be reduced in severe renal impairment as the drug is predominantly excreted by the kidney.

Side Effects

The most common side effects are allergic reactions and skin rashes. Much less common are more serious reactions such as Stevens-Johnsons syndrome and various blood dyscrasias.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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