ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Trimethoprim and polymyxin B: Drug information

Trimethoprim and polymyxin B: Drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Trimethoprim and polymyxin B: Patient drug information" and "Trimethoprim and polymyxin B: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Polytrim [DSC]
Brand Names: Canada
  • Polytrim
Pharmacologic Category
  • Antibiotic, Ophthalmic
Dosing: Adult
Ocular infections, mild to moderate

Ocular infections, mild to moderate (bacterial conjunctivitis, blepharoconjunctivitis): Ophthalmic: Instill 1 drop in affected eye(s) every 3 hours (maximum: 6 doses per day) for 7 to 10 days; has also been used 4 times daily for 5 to 7 days (Ref).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Trimethoprim and polymyxin B: Pediatric drug information")

Conjunctivitis, blepharoconjunctivitis

Conjunctivitis, blepharoconjunctivitis: Infants ≥2 months, Children, and Adolescents: Ophthalmic: Instill 1 drop in eye(s) every 3 hours; maximum daily dose: 6 doses/day for 7 to 10 days; in children and adolescents, 4 times daily dosing for 5 to 7 days has also been used (Ref).

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in manufacturer’s labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in manufacturer’s labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Dermatologic: Circumocular rash

Ophthalmic: Burning sensation of eyes, eyelid edema, eye pruritus, eye redness (increased), lacrimation, stinging of eyes

Contraindications

Hypersensitivity to trimethoprim, polymyxin B, or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Superinfection: Prolonged use may lead to overgrowth of nonsusceptible organisms, including fungi. If superinfection is suspected, institute appropriate alternative therapy.

Special populations:

• Pediatrics: Not indicated for prophylaxis or treatment of ophthalmia neonatorum.

Other warnings/precautions:

• Appropriate use: For topical ophthalmic use only. Do not introduce directly into anterior chamber of the eye. Inadvertent contamination of multiple-dose ophthalmic tube tip has caused bacterial keratitis. Contact lenses should not be worn during therapy.

Warnings: Additional Pediatric Considerations

Not indicated for prophylaxis or treatment of ophthalmia neonatorum.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, ophthalmic: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL (10 mL)

Polytrim: Trimethoprim 1 mg and polymyxin B sulfate 10,000 units per 1 mL (10 mL [DSC]) [contains benzalkonium chloride]

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Polymyxin B-Trimethoprim Ophthalmic)

10000 unit/mL 0.1% (per mL): $1.31 - $1.74

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Ophthalmic: For ophthalmic use only; not for injection into the eye. Avoid contamination of the applicator tip with material from eye, fingers, or other sources. Avoid wearing contact lenses.

Administration: Pediatric

For topical use in eye only; not for injection. Avoid contamination of the applicator tip. Avoid wearing contact lenses. Apply finger pressure to lacrimal sac during and for 1 to 2 minutes after instillation to decrease risk of absorption and systemic effects.

Use: Labeled Indications

Ocular infections, mild to moderate: Treatment of surface ocular bacterial infections, including conjunctivitis and blepharoconjunctivitis, caused by susceptible organisms.

Metabolism/Transport Effects

Refer to individual components.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Amantadine: Trimethoprim may enhance the adverse/toxic effect of Amantadine. Specifically, the risk of myoclonus or delirium may be increased. Trimethoprim may increase the serum concentration of Amantadine. Risk C: Monitor therapy

Aminoglycosides: Polymyxin B may enhance the nephrotoxic effect of Aminoglycosides. Polymyxin B may enhance the neurotoxic effect of Aminoglycosides. Risk X: Avoid combination

Amodiaquine: Trimethoprim may enhance the neutropenic effect of Amodiaquine. Trimethoprim may increase the serum concentration of Amodiaquine. Management: Avoid coadministration of sulfamethoxazole/trimethoprim and amodiaquine in HIV-infected patients when possible due to the possible increased risk for neutropenia. If coadministration is required, monitor closely for neutropenia. Risk D: Consider therapy modification

Angiotensin II Receptor Blockers: Trimethoprim may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Trimethoprim may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy

AzaTHIOprine: Trimethoprim may enhance the myelosuppressive effect of AzaTHIOprine. Risk C: Monitor therapy

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

Bacitracin (Systemic): Polymyxin B may enhance the nephrotoxic effect of Bacitracin (Systemic). Risk X: Avoid combination

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Capreomycin: May enhance the neuromuscular-blocking effect of Polymyxin B. Risk C: Monitor therapy

Cefazedone: May enhance the nephrotoxic effect of Polymyxin B. Risk C: Monitor therapy

Cephaloridine: Polymyxin B may enhance the nephrotoxic effect of Cephaloridine. Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Clofarabine: OCT2 Inhibitors may increase the serum concentration of Clofarabine. Risk C: Monitor therapy

Colistimethate: May enhance the nephrotoxic effect of Polymyxin B. Polymyxin B may enhance the neuromuscular-blocking effect of Colistimethate. Colistimethate may enhance the neurotoxic effect of Polymyxin B. Management: Coadministration of polymyxin B and other potentially neurotoxic or nephrotoxic agents, such as colistimethate, is generally not recommended. If this combination must be used, monitor carefully for enhanced neurotoxic and nephrotoxic effects. Risk D: Consider therapy modification

Dalfampridine: OCT2 Inhibitors may increase the serum concentration of Dalfampridine. Management: Consider alternatives to this combination. Carefully weigh the risk of seizures against the benefit of combining OCT2 inhibitors with dalfampridine. Risk D: Consider therapy modification

Daprodustat: CYP2C8 Inhibitors (Weak) may increase the serum concentration of Daprodustat. Risk C: Monitor therapy

Dapsone (Systemic): Trimethoprim may increase the serum concentration of Dapsone (Systemic). Dapsone (Systemic) may increase the serum concentration of Trimethoprim. Risk C: Monitor therapy

Digoxin: Trimethoprim may increase the serum concentration of Digoxin. Risk C: Monitor therapy

Dofetilide: Trimethoprim may increase the serum concentration of Dofetilide. Risk X: Avoid combination

Eplerenone: Trimethoprim may enhance the hyperkalemic effect of Eplerenone. Risk C: Monitor therapy

Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination

Fosphenytoin-Phenytoin: Trimethoprim may increase the serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor therapy

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy

Kanamycin: Polymyxin B may enhance the adverse/toxic effect of Kanamycin. Management: Coadministration of kanamycin and other potentially ototoxic or nephrotoxic agents, such as polymyxin B, is not recommended. If this combination must be used, monitor carefully neurotoxic, ototoxic, or nephrotoxic effects. Risk D: Consider therapy modification

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

LamiVUDine: Trimethoprim may increase the serum concentration of LamiVUDine. Risk C: Monitor therapy

Leucovorin Calcium-Levoleucovorin: May diminish the therapeutic effect of Trimethoprim. Management: Avoid concurrent use of leucovorin or levoleucovorin with trimethoprim (plus sulfamethoxazole) for Pneumocystis jirovecii pneumonia. If trimethoprim is used for another indication, monitor closely for reduced efficacy. Risk X: Avoid combination

Mecamylamine: Polymyxin B may enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination

Memantine: Trimethoprim may enhance the adverse/toxic effect of Memantine. Specifically, the risk of myoclonus and/or delirium may be increased. Trimethoprim may increase the serum concentration of Memantine. Risk C: Monitor therapy

Mercaptopurine: Trimethoprim may enhance the myelosuppressive effect of Mercaptopurine. Risk C: Monitor therapy

MetFORMIN: MATE1/2-K Inhibitors may increase the serum concentration of MetFORMIN. Risk C: Monitor therapy

Methotrexate: Trimethoprim may enhance the adverse/toxic effect of Methotrexate. Management: Consider avoiding concomitant use of methotrexate and either sulfamethoxazole or trimethoprim. If used concomitantly, monitor for the development of signs and symptoms of methotrexate toxicity (e.g., bone marrow suppression). Risk D: Consider therapy modification

Methoxyflurane: May enhance the nephrotoxic effect of Polymyxin B. Risk X: Avoid combination

Mycophenolate: Antibiotics may decrease serum concentrations of the active metabolite(s) of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor therapy

Netilmicin (Ophthalmic): Polymyxin B may enhance the nephrotoxic effect of Netilmicin (Ophthalmic). Risk X: Avoid combination

Neuromuscular-Blocking Agents: Polymyxin B may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Management: If possible, avoid concomitant use of neuromuscular-blocking agents and polymyxin B. If concomitant use cannot be avoided, monitor for deeper, prolonged neuromuscular-blocking effects (eg, respiratory paralysis) in patients receiving this combination. Risk D: Consider therapy modification

PRALAtrexate: Trimethoprim may increase the serum concentration of PRALAtrexate. More specifically, trimethoprim may decrease excretion of pralatrexate. Risk C: Monitor therapy

Procainamide: Trimethoprim may increase serum concentrations of the active metabolite(s) of Procainamide. Trimethoprim may increase the serum concentration of Procainamide. Management: Consider alternatives to trimethoprim-containing regimens to avoid this interaction. If coadministered, monitor for increased procainamide adverse effects (increased QTc) if trimethoprim is initiated/dose increased. Risk D: Consider therapy modification

Pyrimethamine: May enhance the adverse/toxic effect of Trimethoprim. Risk C: Monitor therapy

Repaglinide: CYP2C8 Inhibitors (Weak) may increase the serum concentration of Repaglinide. Risk C: Monitor therapy

RifAMPin: May decrease the serum concentration of Trimethoprim. Trimethoprim may increase the serum concentration of RifAMPin. Risk C: Monitor therapy

Sapropterin: Trimethoprim may decrease the serum concentration of Sapropterin. Specifically, trimethoprim may decrease tissue concentrations of tetrahydrobiopterin. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Spironolactone: Trimethoprim may enhance the hyperkalemic effect of Spironolactone. Risk C: Monitor therapy

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Zidovudine: May enhance the neutropenic effect of Trimethoprim. Trimethoprim may increase the serum concentration of Zidovudine. Risk C: Monitor therapy

Pregnancy Considerations

Adverse events have been observed with trimethoprim in animal reproduction studies; animal reproduction studies have not been conducted with polymyxin B. See individual agents. If ophthalmic agents are needed during pregnancy, the minimum effective dose should be used in combination with punctal occlusion to decrease potential exposure to the fetus (Samples 1988).

Breastfeeding Considerations

It is not known if trimethoprim or polymyxin B can be detected in breast milk following ophthalmic administration. The manufacturer recommends that caution be exercised when administering trimethoprim/polymyxin B to nursing women. See individual agents.

Pharmacokinetics (Adult Data Unless Noted)

Also see individual agents.

Absorption: Trimethoprim and polymyxin B are systemically absorbed following ophthalmic installation. Peak concentrations were trimethoprim 0.03 mcg/mL and polymyxin B 1 unit/mL.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Oftalmotrim;
  • (AR) Argentina: Neoftalm;
  • (BE) Belgium: Ophtalmotrim | Polytrim;
  • (CO) Colombia: Destrim;
  • (EG) Egypt: Oftalmotrim;
  • (ES) Spain: Oftalmotrin;
  • (GB) United Kingdom: Polytrim;
  • (IN) India: Cadiprim;
  • (JO) Jordan: Oftalmotrim;
  • (KW) Kuwait: Oftalmotrim;
  • (LB) Lebanon: Oftalmotrin;
  • (LU) Luxembourg: Ophtalmotrim | Polytrim;
  • (MA) Morocco: Oftalmotrim;
  • (MY) Malaysia: Oftalmotrim | Oriprim p;
  • (NL) Netherlands: Polytrim;
  • (PK) Pakistan: Polyprim;
  • (PL) Poland: Oftalmotrim;
  • (PR) Puerto Rico: Polymyxin b -trimethoprim ophtha. | Polymyxin b sulfate and trimethoprim | Polymyxin b sulfate and trimethoprim ophthalm | Polytrim;
  • (RU) Russian Federation: Oriprim p;
  • (SA) Saudi Arabia: Ofthalmotrim;
  • (SG) Singapore: Primoptic;
  • (TR) Turkey: Oftalmotrim | Polycilline | Polytrim;
  • (TW) Taiwan: Polytrim;
  • (ZA) South Africa: Polytrim;
  • (ZM) Zambia: Cadiprim | Oftalmotrim
  1. Polytrim solution (trimethoprim and polymyxin B) [prescribing information]. Irvine CA: Allergan Inc; January 2012.
  2. Samples JR and Meyer SM, "Use of Ophthalmic Medications in Pregnant and Nursing Women," Am J Ophthalmol, 1988, 106(5):616-23. [PubMed 2903673]
  3. Trimethoprim sulfate and polymyxin B sulfate solution [prescribing information]. Lake Forest, IL: Akorn, Inc; October 2008.
  4. The Wills Eye Manual, Chapter 5, "Conjunctiva/Sclera/Iris/External Disease," 4th ed, Kunimoto DY, Kanitkar KD, and Makar MS, eds, Philadelphia, PA: Lippincott Williams & Wilkins, 2004.
  5. Williams L, Malhotra Y, Murante B, et al, “A Single-Blinded Randomized Clinical Trial Comparing Polymyxin B-Trimethoprim and Moxifloxacin for Treatment of Acute Conjunctivitis in Children,” J Pediatr, 2013, 162(4):857-61. [PubMed 23092529]
Topic 10102 Version 205.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟