Cotrim DS: A Synergistic Antibiotic for Wide-Ranging Bacterial Infections

Cotrim DS contains Cotrimoxazole, a combination of Trimethoprim and Sulphamethoxazole. It exhibits broad-spectrum bactericidal activity against a wide range of Gram-positive and Gram-negative organisms. This combination provides a synergistic effect, enhancing its bactericidal activity.

How Cotrim DS Works (Pharmacology)

Cotrimoxazole works by the sequential blockade of two bacterial enzyme systems involved in the biosynthesis of folinic acid within microorganisms. Folinic acid is essential for bacterial growth and replication. By blocking these two enzymes, Cotrimoxazole effectively inhibits bacterial growth and leads to bacterial cell death.

It is active against a wide range of bacteria, including Streptococcus, Staphylococcus, Pneumococcus, Neisseria, B. catarrhalis, Escherichia coli, Klebsiella, Proteus spp., Haemophilus, Salmonella, Shigella, Vibrio cholerae, Brucella, Pneumocystis carinii, Nocardia, and Bordetella. It shows particularly high activity against Haemophilus influenzae, E. coli, and Proteus spp.

Key Indications & Benefits

Cotrim DS is indicated for the treatment of various infections, particularly those caused by susceptible organisms where the therapeutic benefits outweigh potential adverse events.

• Respiratory Tract Infections: Acute and chronic bronchitis (treatment and prophylaxis), bronchiectasis, lung abscess, lobar and broncho-pneumonia, Pneumocystis carinii pneumonitis, sinusitis, and otitis media.
• Genito-urinary Tract Infections: Urethritis, acute and chronic cystitis, pyelonephritis, prostatitis, and gonorrhoea.
• Gastro-intestinal Tract Infections: Caused by Salmonella typhi and Salmonella paratyphi (including the chronic carrier state), bacillary dysentery, and cholera (as an adjuvant to fluid and electrolyte replacement).
• Other Infections: Acute and chronic osteomyelitis, acute brucellosis, skin infections (pyoderma, abscesses, wound infections), septicemia, nocardiosis, and mycetoma.

Dosage & Administration

Cotrimoxazole dosage varies based on the formulation (double strength tablet, tablet, suspension), age, and severity of infection.

Cotrimoxazole Double Strength (DS) Tablet (Over 12 years):

• Mild to moderate infections: 1 tablet twice daily.
• Severe infections: 1.5 tablets twice daily.
• Long term therapy (>14 days): 0.5 tablet twice daily.
• Gonorrhoea: 2 tablets every 12 hours for two days or 2.5 tablets followed by a further dose of 2.5 tablets after 8 hours.

Cotrimoxazole Tablet (Over 12 years):

• Mild to moderate infections: 2 tablets twice daily.
• Severe infections: 2 tablets thrice daily.
• Long term therapy (>14 days): 1 tablet twice daily.

Cotrimoxazole Suspension (Under 12 years):

• 6-12 years: 2 teaspoonful twice daily.
• 6 months-5 years: 1 teaspoonful twice daily.
• 6 weeks-6 months: 0.5 teaspoonful twice daily.

Always consult a registered physician for medication use.

Important Considerations & Warnings

Discuss your full medical history with your doctor before taking Cotrim DS.

Contraindications:

• Hypersensitivity to trimethoprim or sulphonamides.
• Patients with documented megaloblastic anemia due to folate deficiency.
• Patients with marked liver parenchymal damage, blood dyscrasia, severe renal insufficiency, or glucose-6-phosphate dehydrogenase deficiency.

Side Effects:

• Rare but serious: Crystalluria, allergic reactions, hemolysis, thrombocytopenia, neutropenia, agranulocytosis.
• Less serious (usually transient): Malaise, headache, nausea, and vomiting. These typically do not require treatment withdrawal.

Pregnancy & Lactation:

• Contraindicated during pregnancy and nursing period because sulphonamides pass the placenta and are excreted in breast milk, potentially causing kernicterus in the infant.

Precautions & Warnings:

• Folate Deficiency/Macrocytic Anemia: Prolonged full-dose treatment may lead to macrocytic anemia due to interference with folic acid conversion. If this occurs, it can be reversed by giving folinic acid.
• Diabetic Patients: Use with care in diabetic patients receiving sulphonylurea drugs, as it may potentiate the action of sulphonylurea.

Storage Conditions

Keep below 30°C temperature, away from light & moisture. Keep out of the reach of children.