Cotrimoxazole - optimal dosing in the critically ill

Annals of Intensive Care

Table 1 Pharmacokinetics of cotrimoxazole (TMP/SMX) in various non-critically ill populations with normal renal and liver function

Population [Reference]	Gender	Age (year)	Weight (kg)	Dose	Route	Duration	Cmax mcg/ml	Tmax (min)	Cmin mcg/ml	Vd (Liters/kg)	T1/2 (hours)	Clearance (ml/min/kg)
Normal [8]	1 F/3 M	34	66	80 mg TMP	PO	Q12h × 9 days				1.5	8.2
				400 mg SMX		Q12h × 9 days				0.26	9.8
Normal [9]	N/A	21 to 40	N/A	240 mg TMP	IV	Q12h × 7 doses	5.91	15	2.64		16.5
				1,200 mg SMX		Q12h × 7 doses	178		78		14.1
Normal [7]	12 M	28	75.8	20.2 mg/kg/day TMP	PO	Q6h × 13 doses	13.6	114		1.4	13.6	1.05
				101.1 mg/kg/day SMX		Q6h × 13 doses	372	156		0.25	14.0	0.024
Normal [6]	6 M	26.7	73.7	12.6 mg/kg/day TMP	PO	Q6h × 3 days	8.3	90	6.1	1.78	14.6	0.89
				63.3 mg/kg/day SMX		Q6h × 3 days	247	108	199	0.27	14.0	0.02
HIV PCP [10]	1 F/22 M	24 to 75	59	15 to 22 mg/kg TMP	IV (15)	Q6h × 4 to 6 days			7.7
				75 to 110 mg/kg SMX	PO (8)	Q6h × 4 to 6 days			198
PCP [2]	N/A	37	67.6	16.1 mg/kg/day TMP	IV	Q6 to 8 h × 2 to 10 days	7.9	15		1.5	11.3	1.73
				80.5 mg/kg/day SMX		Q6 to 8 h × 2 to 10 days	186			0.4	14.3	0.34
Ventilated	N/A	37	68.5	14.7 mg/kg/day TMP	IV	Q6 to 8 h × 2 to 10 days	8.1	15		1.6	10.9	1.88
PCP [2]				73.4 mg/kg/day SMX		Q6 to 8 h × 2 to 10 days	163			0.5	15.5	0.40
Oncology [11]	N/A	N/A	N/A	150 mg/m² TMP	IV	Q8h × 24 hours	7.02	65	3.65		9.60
				750 mg/m² SMX		Q8h × 24 hours	148		88		10.7
Infected	6 F/5 M	60	65	160 mg TMP	IV	Q8h × 4 days	8.8	60	5.6	0.72	11.3	1.13
Cancer [12]				800 SMX		Q8h × 4 days	105.6		70.6	0.27	12.8	0.04
Trauma [3]	2 F/13 M	31	87	8 mg/kg/day TMP	IV	Q12h				2.1	9.8	2.8
				40 mg/kg/day SMX		Q12h				0.51	8.4	0.75

M, male; F, female; Cmax, maximum concentration within the dosing interval; Tmax, time to reach maximum concentration; Cmin, minimum concentration within dosing interval.
Vd, volume of distribution; T1/2, calculated half-life; N/A, not available; PO, oral administration; IV, intravenous administration; PCP, Pneumocystis jovenii pneumonitis.