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Annals of Intensive Care

, 4:13

First Online: 28 April 2014Received: 24 November 2013Accepted: 24 March 2014


The optimum dosage regimen for cotrimoxazole in the treatment of life threatening infections due to susceptible organisms encountered in critically ill patients is unclear despite decades of the drug’s use. Therapeutic drug monitoring to determine the appropriate dosing for successful infection eradication is not widely available. The clinician must utilize published pharmacokinetic, pharmacodynamic, and effective inhibitory concentration information to determine potential dosing regimens for individual patients when treating specific pathogens. Using minimum inhibitory concentrations known to successfully block growth for target pathogens, the pharmacokinetics of both trimethoprim and sulfamethoxazole can be utilized to establish empiric dosing regimens for critically ill patients while considering organ of clearance impairment. The author’s recommendations for appropriate dosing regimens are forwarded based on these parameters.

KeywordsCotrimoxazole Trimethoprim Sulfamethoxazole Pharmacokinetics Pharmacodynamics AbbreviationsAPACHE IIAcute Physiology and Chronic Health Evaluation II

CAPDContinuous Ambulatory Peritoneal Dialysis

CLSIClinical and Laboratory Standards Institute

Cmaxmaximum concentration within the dosing interval

Cminminimum concentration within dosing interval

CrClcreatinine clearance

CVVHDFContinuous Veno-venous Hemodiafiltration

ESBLextended-spectrum β-lactamase-producing


MIC90minimum inhibitory concentration adequate to inhibit 90%

MRSAmethicillin-resistant Staphylococcus aureus

NAT2N-acetyltransferase 2

PCPPneumocystis pneumonitis




Tmaxtime to reach maximum concentration


Vdvolume of distribution.

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Autor: Glen R Brown


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