To      : Rose Marie
Re      : Trimethoprim/sulfamethoxazole (Septra, etc)

This product is a combination of trimethoprim and the sulfa
drug, sulfamethoxazole.  It is primarily used for urinary tract infections, but
also other respiratory tract and sinus infections, otitis,  etc. etc.

The only major contraindication is to use this product in the last trimester of
pregnancy or probably during the first 2-4 weeks of life.  Sulfonamides
displace bilirubin off of its protein binding site and make hyperbilirubinemia
much worse,  that is why it is generally contraindicated "during this time
period". After the period where hyperbilirubinemia generally occurs, it is
generally no problem.   I have enclosed data on both the medications.

This product is available in generic form and has a thousand different names,
but it is almost always the same formulation.

Names: Septra, Bactrim, Cotrim, Uroplus SS, Sulfatrim, and dozens of other
generic names.

Regards
Tom Hale



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Trimethoprim            Fax # 1418

Trade:  Proloprim, Trimpex
Uses:   Antibiotic
AAP:    Approved by the American Academy of Pediatrics for use in breastfeeding
mothers

Trimethoprim is an inhibitor of folic acid production in bacteria.  In one
study of 50 patients,  average milk levels were 2.0 mg/L.  Milk:plasma ratio
was 1.25.   In another group of mothers receiving 160 mg 2-4 times daily,
concentrations of 1.2 to 5.5 mg/L were reported in milk.     Because it may
interfere with folate metabolism, use with caution.  However, trimethoprim
apparently poses few problems in full term or older infants.    PHL= 14.7-40
hours (neonate),  5-6 hours (older infants).

Adverse Effects: Rash, pruritus nausea, vomiting, anorexia, altered taste
sensation

AHL= 8-10 hours                 M/P= 1.25
PHL= 14.7-40 hrs (neonate)      PB  = 44%
PK  = 1-4 hours                 Oral= Complete

References:
1.      Miller RD, Salter AJ.  The passage of trimethoprim/sulphamethoxazole
into breast milk and its significance. In Daikos GK, ed. Progress in
Chemotherapy,Proceedings of the Eighth International Congress of
        Chemotherapy, Athens, 1973. Athens:Hellenic Society for Chemotherapy,
687-91, 1974.
2.      Pagliaro and Levin (Eds):  Problems in Pediatric Drug Therapy.  Drug
Intelligence Publications, Hamilton, IL, 1979.


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Sulfamethoxazole        Fax # 1392

Trade:  Gantanol
Uses:   Sulfonamide antibiotic
AAP:    Not reviewed

Sulfamethoxazole is a common and popular sulfonamide antimicrobial.  It is
secreted in breastmilk in small amounts.  It has a longer half-life than other
sulfonamides.   Use with caution in weakened infants and premature infants with
hyperbilirubinemia.  Gantrisin (Sulfisoxazole) is considered the best choice of
sulfonamides due to reduced transfer to infant.  Compatible but exercise
caution.    PHL= 14.7-36.5 hours (neonate),  8-9 hours (older infants).

Adverse Effects: Anemia, blood dyscrasias, allergies

AHL= 10.1 hours         M/P= 0.06
PHL= 36.5 hrs(neonate)  PB  = 62%
PK  = 1-4 hours         Oral= Complete

References:
1.      Rasmussen F. Mammary excretion of sulfonamides.  Acta Pharmacol Toxicol
15:138-148, 1958.