Trimethoprin-sulfamethoxazole (TMP-SMX)

Combination antimicrobial that synergistically inhibits the sequential steps of bacterial tetrahydrofolate synthesis necessary for microbial purine and DNA production.

Resistance to Gram-negative organisms has markedly increased, limiting its use against infections by such organisms.

Trimethoprim is similar to the potassium sparing diuretic amiloride and reduces urinary potassium excretion by approximately 40%.

The use of trimethoprim-sulfamethoxazole in older patients with ace inhibitors or ARB’s is associated with an increased risk of hyperkalemia relative to other antibiotics.

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