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1
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Kalkut, G. Sulfonamides and trimethoprim. Cancer Invest 1998; 16:612.
no abstract available
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2
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Trimethoprim: mechanisms of action, antimicrobial activity, bacterial resistance, pharmacokinetics, adverse reactions, and therapeutic indications.
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Gleckman R; Blagg N; Joubert DW
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Pharmacotherapy 1981 Jul-Aug;1(1):14-20.
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Trimethoprim has recently been marketed as a single-entity product for the treatment of initial episodes of uncomplicated symptomatic urinary tract infections; it was previously available only in combination with sulfamethoxazole. Trimethoprim exerts antimicrobial activity by blocking the reduction of dihydrofolate to tetrahydrofolate, the active form of folic acid, by susceptible organisms. It has inhibitory activity for most gram-positive aerobic cocci and some gram-negative aerobic bacilli. Resistance to trimethoprim may be either intrinsic or acquired. Acquired resistance most commonly stems from a chromosomal mutation that results in the production of a dihydrofolate reductase enzyme which is less vulnerable to trimethoprim inhibition. Gastrointestinal intolerance and skin eruptions are the most common untoward reactions resulting from the administration of trimethoprim. Trimethoprim constitutes very effective therapy for women with acute symptomatic urinary tract infections caused by E. coli, and the compound compares favorably with alternative standard agents, such as ampicillin and cephalexin. The safety of trimethoprim in the pregnant woman has not been established. Since indiscriminate use of trimethoprim could foster the emergence of trimethoprim resistance, thereby negating the value of both trimethoprim and trimethoprim-sulfamethoxazole, trimethoprim should only be prescribed for well defined indications. Trimethoprim is currently being investigated as definitive therapy for a wide range of infections, including bacterial exacerbations of chronic bronchitis, bacterialpneumonia, and typhoid fever. Initial reports are encouraging.
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| PMID |
6985448
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5
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Trimethoprim-sulfamethoxazole.
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| AU |
Smilack JD
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Mayo Clin Proc 1999 Jul;74(7):730-4.
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After 25 years of use in the United States, trimethoprim-sulfamethoxazole (TMP-SMX) is widely prescribed for various indications. By virtue of sequential blockade of microbial folic acid synthesis, the antimicrobial combination has excellent in vitro inhibitory activity against many common respiratory and urinary tract pathogens, as well as many nosocomial infecting strains. In patients infected with the human immunodeficiency virus, TMP-SMX provides prophylactic and therapeutic potency against Pneumocystis carinii but at the risk of frequent side effects. TMP-SMX is also used for treatment of pulmonary and disseminated nocardiosis and some forms of Wegener's granulomatosis, as well as for prophylaxis of spontaneous bacterial peritonitis. Increasing bacterial resistance and concern about occasional severe adverse effects suggest that the usefulness of TMP-SMX may diminish in the future.
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Division of Infectious Diseases, Mayo Clinic Scottsdale, Arizona.
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| PMID |
10405706
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6
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Vancomycin, trimethoprim-sulfamethoxazole, and rifampin.
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Lundstrom TS; Sobel JD
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Infect Dis Clin North Am 1995 Sep;9(3):747-67.
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Vancomycin is a safe, effective antibiotic for a variety of serious gram-positive infections. Because of emerging vancomycin-resistant enterococci and the threat of spread of vancomycin-resistant genes to other gram-positive organisms, judicious use of vancomycin should be promoted. Trimethoprim-sulfamethoxazole, a broad-spectrum synergistic combination, continues to find widespread use in gram-negative bacterial infections, especially involving the urinary tract. It has enjoyed enormous success in prophylaxis and therapy of Pneumocystis carinii pneumonia. Rifampin remains of paramount significance as a cidal agent against Mycobacterium tuberculosis; however, increasing reports of strains of MDR-tuberculosis are of great concern.
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Wayne State University School of Medicine, Detroit, Michigan, USA.
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| PMID |
7490442
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7
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Increases in rates of resistance to trimethoprim.
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Huovinen P
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Clin Infect Dis 1997 Jan;24 Suppl 1:S63-6.
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Trimethoprim alone or in combination with a sulfonamide is an effective and relatively inexpensive antibacterial medication. However, a dramatic increase in the rate of resistance to trimethoprim along with high-level resistance to sulfonamides has been seen during the past two decades. The mechanisms of resistance show a remarkable evolutionary adaptation.
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Antimicrobial Research Laboratory, National Public Health Institute, Turku, Finland.
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| PMID |
8994780
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8
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A Canadian national surveillance study of urinary tract isolates from outpatients: comparison of the activities of trimethoprim-sulfamethoxazole, ampicillin, mecillinam, nitrofurantoin, and ciprofloxacin. The Canadian Urinary Isolate Study Group.
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Zhanel GG; Karlowsky JA; Harding GK; Carrie A; Mazzulli T; Low DE; Hoban DJ
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Antimicrob Agents Chemother 2000 Apr;44(4):1089-92.
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Ampicillin, trimethoprim-sulfamethoxazole, mecillinam, nitrofurantoin, and ciprofloxacin mean resistance rates for 2,000 urinary tract isolates collected from outpatients across Canada in 1998 were 41.1, 19.2, 14.7, 5.0, and 1.8%, respectively. For Escherichia coli isolates alone (n = 1,681) comparable rates were 41. 0, 18.9, 7.4, 0.1, and 1.2%, respectively. The majority of E. coli isolates resistant to ampicillin, trimethoprim-sulfamethoxazole, or ciprofloxacin were susceptible (MIC,<16 microg/ml) to mecillinam.
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Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Health Sciences Centre, Manitoba, Canada. ggzhanel@pcs.mb.ca
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| PMID |
10722520
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