Lihat sumber Kotrimoksazol

{{Drugbox
| verifiedrevid = 388518461
| image = Trimethoprim and sulfamethoxazole.svg
| width = 250px
| caption = '''Trimetoprim''' (atas) dan '''sulfametoksazol''' (bawah)
<!--Combo data-->
| type = combo
| component1 = Trimetoprim
| class1 = Inhibitor [[Dihidrofolat reduktase]] 
| component2 = Sulfametoksazol
| class2 = [[Sulfonamida (obat)|Antibiotik sulfonamida]]
<!--Clinical data-->
| tradename = Bactrim, Cotrim, Septra, lainnya
| BAN = Ko-trimoksazol
| Drugs.com = {{drugs.com|monograph|co-trimoxazole}}
| pregnancy_AU = C
| pregnancy_US = D
| pregnancy_US_comment = <ref name=AHFS2015/>
| pregnancy_category =
| legal_AU = S4
| legal_CA = Rx-only
| legal_UK = POM
| legal_US = Rx-only
| legal_status =
| routes_of_administration = Oral, intravena<ref name=AHFS2015/>

<!--Identifiers-->
| CAS_number = 8064-90-2
| ATC_prefix = J01
| ATC_suffix = EE01
| PubChem = 358641
| DrugBank = DB00440
| ChEBI = 3770
| ChemSpiderID = 318412
<!--Chemical data-->
}}
<span data-segmentid="116" class="cx-segment">'''Trimetoprim/sulfametoksazol''' ('''TMP/SMX'''), atau '''ko-trimoksazol''', adalah [[antibiotik]] digunakan untuk mengobati berbagai infeksi bakteri.<ref name="AHFS2015">{{Cite web|url=https://www.drugs.com/monograph/co-trimoxazole.html|title=Co-trimoxazole|publisher=The American Society of Health-System Pharmacists|archive-url=https://web.archive.org/web/20150906003435/http://www.drugs.com/monograph/co-trimoxazole.html|archive-date=2015-09-06|dead-url=no|access-date=Aug 1, 2015}}</ref></span> Obat ini terdiri dari <span data-segmentid="119" class="cx-segment">satu bagian [[trimetoprim]] dan lima bagian [[sulfametoksazol]].<ref name="Ric2015">{{Cite book|last=Hamilton|first=Richart|title=Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition|date=2015|publisher=Jones & Bartlett Learning|isbn=9781284057560|page=105}}</ref></span> Obat ini diindikasikan untuk pengobatan <span data-segmentid="122" class="cx-segment">[[infeksi saluran kemih]], [[Infeksi saluran kemih|infeksi]] kulit akibat ''[[Staphylococcus aureus]]'' yang resisten metisilin, diare pelancong, infeksi saluran pernapasan, [[kolera]], dan lainnya.<ref name="AHFS2015" /><ref name="Ric2015" /></span> Obat i<span data-segmentid="128" class="cx-segment">ni dapat digunakan untuk mengobati dan mencegah [[pneumonia pneumocystis]] dan [[toksoplasmosis]] pada pasien [[AIDS|HIV/AIDS]].<ref name="AHFS2015" /></span> Obat ini dapat diminum atau diberikan secara <span data-segmentid="132" class="cx-segment">intravena.<ref name="AHFS2015" /></span>

<span data-segmentid="133" class="cx-segment">Efek samping yang umum terjadi antara lain [[mual]], [[muntah]], ruam, dan [[diare]].<ref name="AHFS2015" /></span> Efek samping yang lebih berat seperti r<span data-segmentid="137" class="cx-segment">eaksi [[alergi]] parah dan infeksi akibat ''[[Clostridium difficile]]'' terkadang dapat terjadi.<ref name="AHFS2015" /></span> <span data-segmentid="140" class="cx-segment">Pasien yang sedang [[Kehamilan|hamil]] di trimester akhir tidak direkomendasikan untuk menerima obat ini.<ref name="AHFS2015" /></span> Obat ini <span data-segmentid="142" class="cx-segment">aman digunakan pada pasien yang sedang [[menyusui]] selama bayi memiliki kondisi yang sehat.<ref>{{Cite web|url=https://www.drugs.com/pregnancy/sulfamethoxazole-trimethoprim.html|title=Sulfamethoxazole / trimethoprim Pregnancy and Breastfeeding Warnings|archive-url=https://web.archive.org/web/20150906073951/http://www.drugs.com/pregnancy/sulfamethoxazole-trimethoprim.html|archive-date=6 September 2015|dead-url=no|access-date=31 August 2015}}</ref></span> <span data-segmentid="144" class="cx-segment">TMP/SMX bersifat bakterisida.<ref name="AHFS2015" /></span> TMP/SMX <span data-segmentid="145" class="cx-segment">bekerja dengan menghambat sintesis folat pada bakteri.<ref name="AHFS2015" /></span>

<span data-segmentid="148" class="cx-segment">TMP/SMX pertama kali dipasarkan pada tahun 1974.<ref>{{Cite book|title=Oxford Handbook of Infectious Diseases and Microbiology|date=2009|publisher=OUP Oxford|isbn=9780191039621|page=56|url=https://books.google.com/books?id=5W-WBQAAQBAJ&pg=PT56|dead-url=no|archive-url=https://web.archive.org/web/20151124232554/https://books.google.com/books?id=5W-WBQAAQBAJ&pg=PT56|archive-date=2015-11-24}}</ref></span> Obat ini terdapat <span data-segmentid="149" class="cx-segment">dalam [[Daftar Obat Esensial Organisasi Kesehatan Dunia]].<ref name="WHO19th">{{Cite web|url=http://www.who.int/medicines/publications/essentialmedicines/EML_2015_FINAL_amended_NOV2015.pdf?ua=1|title=WHO Model List of Essential Medicines (19th List)|date=April 2015|website=World Health Organization|archive-url=https://web.archive.org/web/20161213052708/http://www.who.int/medicines/publications/essentialmedicines/EML_2015_FINAL_amended_NOV2015.pdf?ua=1|archive-date=13 December 2016|dead-url=no|access-date=8 December 2016}}</ref></span> Obat ini <span data-segmentid="152" class="cx-segment">tersedia dalam bentuk [[Obat generik|generik]].<ref name="Ric2015" /></span>

== Indikasi ==
<span data-segmentid="157" class="cx-segment">Ko-trimoksazol awalnya diklaim lebih efektif dibandingkan dengan penggunaan sulfametoksazol atau trimetoprim saja dalam mengobati infeksi bakteri, tetapi hal ini masih diperdebatkan.<ref>{{Cite journal|last=Brumfitt, W|last2=Hamilton-Miller, JM|date=December 1993|title=Reassessment of the rationale for the combinations of sulphonamides with diaminopyrimidines|journal=Journal of Chemotherapy|volume=5|issue=6|pages=465–9|doi=10.1080/1120009X.1993.11741097|pmid=8195839}}</ref></span> <span data-segmentid="158" class="cx-segment">Karena memiliki angka kejadian efek samping yang lebih tinggi, penggunaannya telah dibatasi hanya untuk keadaan tertentu di berbagai negara.<ref>{{Cite journal|date=December 1995|title=Co-trimoxazole use restricted|journal=Drug Ther Bull|volume=33|issue=12|pages=92–3|doi=10.1136/dtb.1995.331292|pmid=8777892}}</ref></span> Obat ini <span data-segmentid="159" class="cx-segment">efektif untuk [[Infeksi saluran napas atas|infeksi saluran pernapasan atas]] dan bawah, infeksi [[ginjal]] dan [[Infeksi saluran kemih|saluran kemih]], [[Usus|infeksi saluran pencernaan]], infeksi kulit, [[sepsis]], dan infeksi lain yang disebabkan oleh organisme sensitif.</span> K<span data-segmentid="165" class="cx-segment">o-trimoksazol dapat mengurangi risiko kekambuhan retinokoroiditis.<ref name="Pradhan">{{Cite journal|last=Pradhan E, Bhandari S, Gilbert RE, Stanford M|date=2016|title=Antibiotics versus no treatment for toxoplasma retinochoroiditis|journal=Cochrane Database Syst Rev|volume=5|issue=5|pages=CD002218|doi=10.1002/14651858.CD002218.pub2|pmid=27198629}}</ref></span> Karena <span data-segmentid="167" class="cx-segment">[[Resistansi antibiotik|resistensi antibiotik]] yang semakin meluas membuat kotrimoksazol lebih sering digunakan saat ini.<ref>{{Cite journal|date=October 2008|title=Potential of old-generation antibiotics to address current need for new antibiotics|journal=Expert Rev Anti Infect Ther|volume=6|issue=5|pages=593–600|doi=10.1586/14787210.6.5.593|pmid=18847400}}</ref></span>

=== Kepekaan ===
<span data-segmentid="170" class="cx-segment">Kotrimoksazol efektif untuk infeksi akibat organisme berikut:<ref name="MSR3">{{Cite web|url=http://reference.medscape.com/drug/bactrim-trimethoprim-sulfamethoxazole-342543#showall|title=Bactrim, Bactrim DS (trimethoprim/sulfamethoxazole) dosing, indications, interactions, adverse effects, and more|website=Medscape Reference|publisher=WebMD|archive-url=https://web.archive.org/web/20140116124927/http://reference.medscape.com/drug/bactrim-trimethoprim-sulfamethoxazole-342543#showall|archive-date=16 January 2014|dead-url=no|access-date=13 January 2014}}</ref><ref name="Drugs2">{{Cite journal|last=Wormser, GP|last2=Keusch, GT|last3=Heel, RC|date=December 1982|title=Co-trimoxazole (trimethoprim-sulfamethoxazole): an updated review of its antibacterial activity and clinical efficacy|journal=Drugs|volume=24|issue=6|pages=459–518|doi=10.2165/00003495-198224060-00002|pmid=6759092}}</ref></span> {{Div col}}
* ''[[Acinetobacter]]'' spp.
* ''[[Aeromonas hydrophila]]''
* ''[[Alcaligenes xylosoxidans]]''
* ''[[Bartonella henselae]]''
* ''[[Bordetella pertussis]]'' ([[pertusis]])
* ''[[Brucella]]'' spp.
* ''[[Burkholderia cepacia]]''
* ''[[Burkholderia mallei]]''
* ''[[Burkholderia pseudomallei]]'' ([[melioidosis]])
* ''[[Chlamydia trachomatis]]'' ([[infeksi Chlamydia]])
* ''[[Chryseobacterium meningosepticum]]''
* ''[[Citrobacter]]'' spp.
* ''[[Enterobacter]]'' spp.
* ''[[Escherichia coli]]''
* ''[[Haemophilus influenzae]]''
* ''[[Hafnia alvei]]''
* ''[[Kingella]]'' spp.
* ''[[Klebsiella granulomatis]]''
* ''[[Klebsiella pneumoniae]]''
* ''[[Legionella]]'' spp.
* ''[[Listeria monocytogenes]]'' ([[listeriosis]])
* ''[[Moraxella catarrhalis]]''
* ''[[Morganella morganii]]''
* ''[[Mycobacterium tuberculosis]]'' ([[tuberkulosis]])
* ''[[Neisseria gonorrhoeae]]'' ([[gonore]])
* ''[[Neisseria meningitidis]]'' ([[meningokokus]])
* ''[[Nocardia]]'' spp.
* ''[[Plesiomonas shigelloides]]''
* ''[[Pneumocystis jirovecii]]''
* ''[[Proteus mirabilis]]''
* ''[[Proteus vulgaris]]''
* ''[[Providencia rettgeri]]''
* ''[[Providencia stuartii]]''
* ''[[Salmonella typhi]]'' ([[demam tifoid]])
* ''[[Salmonella]]'' non-typhi
* ''[[Serratia]] spp.
* ''[[Shigella]]'' spp.
* ''[[Staphylococcus aureus]]''
* ''[[Staphylococcus epidermidis]]''
* ''[[Staphylococcus saprophyticus]]''
* ''[[Stenotrophomonas maltophilia]]''
* ''[[Streptococcus agalactiae]]''
* ''[[Streptococcus faecalis]]''
* ''[[Streptococcus pneumoniae]]''
* ''[[Streptococcus pyogenes]]''
* ''[[Streptococcus viridans]]''
* ''[[Toxoplasma gondii]]'' ([[toksoplasmosis]])
* ''[[Tropheryma whippelii]]'' ([[Penyakit Whipple]])
* ''[[Vibrio cholerae]]'' ([[kolera]])
* ''[[Yersinia enterocolitica]]''
* ''[[Yersinia pestis]]'' ([[pes bubo]])
* ''[[Yersinia pseudotuberculosis]]''
{{Div col end}}<span data-segmentid="289" class="cx-segment">Beberapa organisme yang resisten terhadap kotrimoksazol adalah ''Pseudomonas aeruginosa'', [[mycoplasma]],<ref name="Drugs2"/> dan ''[[Francisella tularensis]]'' (organisme penyebab [[tularemia]]).<ref>{{Cite web|url=http://new.dhh.louisiana.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/EpiManual/TularemiaManual.pdf|title=TULAREMIA|date=17 July 2011|website=Infectious Disease Epidemiology Section|publisher=Louisiana Office of Public Health|archive-url=https://web.archive.org/web/20140223030105/http://new.dhh.louisiana.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/EpiManual/TularemiaManual.pdf|archive-date=23 February 2014|dead-url=no|access-date=12 February 2014}}</ref><ref>{{Cite journal|last=Harik|first=NS|date=1 July 2013|title=Tularemia: Epidemiology, Diagnosis, and Treatment|url=http://www.healio.com/~/media/Journals/PedAnn/2013/7_July/10_3928_00904481_20130619_13/10_3928_00904481_20130619_13.pdf|dead-url=no|journal=Pediatric Annals|volume=42|issue=7|pages=288–292|doi=10.3928/00904481-20130619-13|pmid=23805970|archive-url=https://web.archive.org/web/20140222045758/http://www.healio.com/~/media/Journals/PedAnn/2013/7_July/10_3928_00904481_20130619_13/10_3928_00904481_20130619_13.pdf|archive-date=22 February 2014}}</ref></span>

=== Kehamilan dan menyusui ===
<span data-segmentid="294" class="cx-segment">Kotrimoksazol dikontraindikasikan pada pasien hamil, walau kategori kehamilan di Australia adalah C dan di Amerika kategori adalah D.<ref name="MSR3"/> Penggunaan kotrimoksazol selama trimester pertama (selama [[organogenesis]]) dan 12 minggu sebelum kehamilan dapat menyebabkan cacat pada janin</span><span data-segmentid="298" class="cx-segment">.<ref name="MSR3"/></span> <span data-segmentid="300" class="cx-segment">Penggunaan kotrimoksazol juga meningkatkan risiko persalinan prematur (nisbah jangkaan: 1,51) dan berat bayi saat lahir yang rendah (nisbah jangkaan: 1,67).<ref>{{Cite journal|last=Yang, J|last2=Xie, RH|last3=Krewski, D|last4=Wang, YJ|last5=Walker, M|last6=Wen, SW|date=May 2011|title=Exposure to trimethoprim/sulfamethoxazole but not other FDA category C and D anti-infectives is associated with increased risks of preterm birth and low birth weight|journal=International Journal of Infectious Diseases|volume=15|issue=5|pages=e336–e341|doi=10.1016/j.ijid.2011.01.007|pmid=21345707}}</ref><ref>{{Cite journal|last=Santos, F|last2=Sheehy, O|last3=Perreault, S|last4=Ferreira, E|last5=Berard, A|date=October 2011|title=Exposure to anti-infective drugs during pregnancy and the risk of small-for-gestational-age newborns: a case–control study|journal=BJOG|volume=118|issue=11|pages=1374–1382|doi=10.1111/j.1471-0528.2011.03041.x|pmid=21749628}}</ref></span> <span data-segmentid="301" class="cx-segment">Penelitian pada hewan juga menunjukkan hal yang serupa.<ref name="TGA2">{{Cite web|url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-01070-3|title=BACTRIM®|date=18 September 2012|website=TGA eBusiness Services|publisher=Roche Products Pty Limited|format=PDF|access-date=13 January 2014}}</ref></span> Kotrimoksazol <span data-segmentid="302" class="cx-segment">juga terdapat dalam ASI dan karena hal itu tidak disarankan untuk menyusui selama pengobatan dengan kotrimoksazol.<ref name="MSR3"/></span>

=== Bayi ===
<span data-segmentid="304" class="cx-segment">Penggunaan kotrimoksazol pada bayi berusia kurang dari 2 bulan tidak disarankan karena adanya risiko efek samping.<ref>{{Cite web|url=https://www.minarsdermatology.com/for-dermatologists/pediatric-dosing/bactrim/|title=Bactrim Dosage Guide|website=Minars Dermatology|language=en|access-date=2019-04-19}}</ref><ref>{{Cite web|url=https://www.webmd.com/drugs/2/drug-5530/bactrim-ds-oral/details/list-sideeffects|title=Drugs & Medications|website=www.webmd.com|language=en|access-date=2019-04-19}}</ref></span>

== Reaksi simpang ==

=== Kontraindikasi ===
<span data-segmentid="307" class="cx-segment">Kontraindikasi kotrimoksazol antara lain:<ref name="MSR3"/><ref name="EMC">{{Cite web|url=http://www.medicines.org.uk/emc/medicine/23909/SPC/Co-Trimoxazole+Tablets+80+400mg/|title=Co-Trimoxazole Tablets 80/400mg - Summary of Product Characteristics (SPC)|date=17 October 2012|website=electronic Medicines Compendium|publisher=Actavis UK Ltd|archive-url=https://web.archive.org/web/20140113204303/http://www.medicines.org.uk/emc/medicine/23909/SPC/Co-Trimoxazole+Tablets+80+400mg/|archive-date=13 January 2014|dead-url=no|access-date=13 January 2014}}</ref></span> {{Div col|colwidth=30em}}
* Hipersensitivitas terhadap komponen obat
* Kehamilan
* Kerusakan hati yang parah
* Gangguan hematologi yang parah dan [[porfiria]] (karena adanya sulfonamida).
* Gangguan ginjal berat (CrCl <15 ml/menit)
* Neonatus selama 6 minggu pertama. Kecuali untuk pengobatan/profilaksis pneumositosis jiroveci (''P. carinii'') pada bayi berumum 4 minggu ke atas.
{{Div col end}}

=== Efek samping ===
<span data-segmentid="375" class="cx-segment">Efek samping yang terjadi antara lain:<ref name="TGA2"/></span> {{Div col|colwidth=20em}}
* Mual
* Muntah
* Pusing
* Sakit kepala
* Depresi
* Bingung
* Trombositopenia
* [[Uremia]] pada pasien dengan gangguan ginjal
* Gangguan sumsum tulang belakang
* Hilang nafsu makan
* Tidak sadarkan diri
{{Div col end}}

== Referensi ==
<references />

[[Kategori:Obat Esensial Organisasi Kesehatan Dunia]]