TMP/SMX (trimethoprim/sulfamethoxazole)

Dosing: Adult Antimicrobial Dosing, Non-dialysis

Indication CrCl > 30 mL/min 15-30 mL/min < 15 mL/min
Systemic GNR infections, Nocardia 10 mg TMP/kg/day divided Q6-12h 5 mg TMP/kg/day divided Q6-12h 2.5 mg TMP/kg Q24h
Pneumocystis pneumonia, CNS infections 15 - 20 mg TMP/kg/day divided Q6 – 12h 7.5-10 mg TMP/kg/day  divided Q12-24h 4 - 5 mg TMP/kg Q24h

Dosing: Antimicrobial Dosing in Intermittent & Continuous Hemodialysis


Intermittent Hemodialysis

Continuous Hemodialysis
Systemic GNR Infections, Nocardia 2.5 - 5 mg TMP/kg x1 now and qPM 5 - 7.5 mg TMP/kg/day divided q12h
Pneumocystis pneumonia 5 - 10 mg TMP/kg IV x1 now and qPM 10 - 15 mg TMP/kg/day IV divided q6h - q12h

Dialysis Notes

Intermittent HD assumes high-flux hemodialysis. CRRT assumes CVVHD with ultrafiltration rate 2L/h and residual native GFR < 10 mL/min.  For detailed view of dialysis dosing and evidence, see Dosing in Hemodialysis document.

Single-strength (SS) tablet contains 80 mg trimethoprim (TMP)

Double-strength (DS) tablet contains 160 mg trimethoprim (TMP)

*May consider Total BW for serious infections