title: Clinical use of trimethoprim/sulfamethoxazole during renal dysfunction.
abstract: This article reviews the pharmacokinetics, clinical use, and adverse effects of trimethoprim/sulfamethoxazole (TMP/SMX) in renally impaired patients. Renal dysfunction changes the pharmacokinetics of both component drugs. TMP and SMX disposition are not significantly altered until creatinine clearance is less than 30 mL/min, when SMX metabolites and TMP accumulate and may lead to toxicity. Renal dysfunction, however, does not preclude the use of TMP/SMX to treat susceptible infections, even when creatinine clearance is less than 15 mL/min. Adverse effects may occur more frequently in renally impaired patients but are not clearly related to increased serum concentrations of either drug. Guidelines for appropriate dosing and monitoring of TMP/SMX therapy in these patients are presented.
authors.affiliation: College of Pharmacy, Ohio State University.
authors.forename: C M
authors.initials: CM
authors.lastname: Paap
authors.forename: M C
authors.initials: MC
authors.lastname: Nahata
mesh_terms: D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination