Like all antibiotics, Co-trimoxazole only works against some types of bacteria. This means that it is only suitable for treating some types of infections.

 Co-trimoxazole can be used to treat or prevent:

• Lung infections (pneumonia or PJP) caused by a bacteria called Pneumocystis jirovecii.
• Infections caused by a bacteria called Toxoplasma (toxoplasmosis).

Co-trimoxazole can be used to treat:

• Urinary bladder or urinary tract infections (water infections)
• Respiratory tract infections such as bronchitis
• Ear infections such as otitis media
• An infection called nocardiosis which can affect the lungs, skin and brain.

Co-trimoxazole DS tablets are indicated in children (>12 to 18 years old). Consideration should be given to official guidance on the appropriate use of antibacterial agents.

Do not take Co-trimoxazole if

• You are allergic to sulfamethoxazole, trimethoprim or co-trimoxazole
• You are allergic to sulphonamide medicines. Examples include sulphonylureas (such as gliclazide and glibenclamide) or thiazide diuretics (such as bendroflumethiazide – a water tablet).
• You have severe liver or kidney problemsYou have ever had a problem with your blood causing bruises or bleeding (thrombocytopenia).
• You have been told that you have a rare blood problem called porphyria, which can affect your skin or nervous system.
• Co-trimoxazole should not be given to infants during the first 6 weeks of life.

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before taking Co-trimoxazole.

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure.

Standard Dose

Standard dosage recommendations for acute infections

Adults (>18 years old): One tablet Co-trimoxazole DS in the morning and one tablet in an evening

Children over 12 years (>12 to < 18 years old): The dosage for children is equivalent to approximately 6 mg trimethoprim and 30 mg sulfamethoxazole per kg body weight per day.

The schedules for children are according to the child’s age and body weight and provided in the tables below:

>12 to <18 years old:- One tablet in the morning and one tablet in an evening

>53 kg:- One tablet every 12 hours

• Co-trimoxazole should be taken for at least five days.
• Make sure that you finish the course of Co-trimoxazole which your doctor has prescribed.

Co-trimoxazole Tablets are not usually given to children under 12 years old. If they have been given to your child under 12 years please speak to your doctor or pharmacist for more information

Special Dose

The dose of Co-trimoxazole and how long you need to take it depends on the infection you have and how bad it is.

Your doctor may prescribe you a different dose or length of course of Co-trimoxazole to:

• Treat urinary tract (water) infections.
• Treat and prevent lung infections caused by the bacteria Pneumocystis jirovecii.
• Treat infections caused by the bacteria Toxoplasma (toxoplasmosis) or Nocardia (nocardiosis).

If you have kidney problems your doctor may:

• Prescribe a lower dose of Co-trimoxazole.
• Take blood to test whether the medicine is working properly.

If you take Co-trimoxazole for a long time your doctor may:

• Take blood to test whether the medicine is working properly.
• Prescribe folic acid (a vitamin) for you to take at the same time as Co-trimoxazole.

If you take more Co-trimoxazole Tablets than you should

If you take more Co-trimoxazole than you should talk to your doctor or go to a hospital straight away. Take the medicine pack with you. If you have taken too much Co-trimoxazole you may:

• Feel or be sick.
• Feel dizzy or confused.

If you forget to take a dose of Co-trimoxazole Tablets

If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose. Do not double-up the next dose to make up for the missed dose.

If you stop taking Co-trimoxazole Tablets

Do not stop taking Co-trimoxazole Tablets just because you feel better. You must complete the course of tablets that your doctor has

prescribed for you. If you stop taking the tablets too soon, the infection may return, your condition may get worse or the bacteria may become resistant to the medicine.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

Other medicines and Co-trimoxazole

Tell your doctor or pharmacist if you are taking, have recently taken or may take any other medicines. This is because Co-trimoxazole can affect the way some medicines work. Also, some other medicines can affect the way Co-trimoxazole works. In particular, tell your doctor or

pharmacist if you are taking any of the following medicines: Diuretics (water tablets),  Pyrimethamine, Ciclosporin, Blood thinners such as warfarin, Phenytoin, Medicines used to treat diabetes, such

as glibenclamide, glipizide or tolbutamide (sulphonylureas) and repaglinide, Rifampicin, Medicines to treat problems with the way your heart beats such as digoxin or procainamide., Amantadine, Medicines to treat HIV  called zidovudine or lamivudine, Medicines that can increase the amount of potassium in your blood, such as diuretics (water tablets, which help increase the amount of urine you produce, such as spironolactone), steroids (like prednisolone) and digoxin., Methotrexate,  Folinic acid, Contraceptive medicines.

Possible side effects

Like all medicines, Co-trimoxazole can cause side effects, although not everybody gets them. You may experience the following side effects with this medicine.

Stop taking Co-trimoxazole and tell your doctor immediately if you have an allergic reaction. Chances of an allergic reaction are very rare (fewer than 1 in 10,000 people are affected), signs of an allergic reaction include Allergic reactions 

• Difficulty in breathing
• Fainting
• Swelling of face
• Swelling of mouth, tongue or throat which may be red and painful and/or cause difficulty in swallowing
• Chest pain 
• Red patches on the skin Very Common (more than 1 in 10 people)
• High levels of potassium in your blood, which can cause abnormal heartbeats (palpitations). Common (less than 1 in 10 people)
• A fungal infection called thrush or candidiasis which can affect your mouth or vagina.
• Headache
• Feeling sick (nausea)
• Diarrhoea
• Skin rashes Uncommon (less than 1 in 100)
• Being sick (vomiting).

Warnings and precautions

Talk to your doctor or pharmacist before taking Co-trimoxazole:

• If you have severe allergies or asthma.
• Potentially life-threatening skin rashes (Stevens-Johnson syndrome, toxic epidermal necrolysis) have been reported with the use of Co-trimoxazole appearing initially as reddish target-like spots or circular patches often with central blisters on the trunk.
• At the start of treatment, the occurrence of generalised skin redness with pustules, accompanied by fever, should raise the suspicion of a serious reaction called generalised acute exanthematous pustulosis (AGEP).
• Additional signs to look for include ulcers in the mouth, throat, nose, genitals and conjunctivitis (red and swollen eyes).
• These potentially life-threatening skin rashes are often accompanied by flu-like symptoms. The rash may progress to widespread blistering or peeling of the skin.
• The highest risk for occurrence of serious skin reactions is within the first weeks of treatment.
• If you have developed Stevens-Johnson syndrome or toxic epidermal necrolysis with the use of Co-trimoxazole you must not be re-started on Co-trimoxazole at any time.
• If you develop a rash or these skin symptoms, stop taking Co-trimoxazole, seek urgent advice from a doctor and tell him that you are taking this medicine.
• If you have been told that you are at risk for a rare blood disorder called porphyria.
• If you have kidney disease.
• If you don’t have enough folic acid (a vitamin) in your body – which can make your skin pale and make you feel tired, weak and breathless. This is known as anaemia.
• If you have a disease called glucose-6-phosphate dehydrogenase deficiency, which can cause jaundice or spontaneous destruction of red blood cells. If you have a problem with your metabolism called phenylketonuria and are not on a special diet to help your condition.
• If you are elderly.
• If you are underweight or malnourished.
• If you have been told by your doctor that you have a lot of potassium in your blood.