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Bactrim

Bactrim
Bactrim is used to treat infections of the respiratory tract and ENT organs: exacerbation of chronic bronchitis, otitis media in children.

Brand: Sulfamethoxazole & Trimethoprim

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: November 2023
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Bactrim 800/160 mg
360 pills - 800/160 mg
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Bactrim 400/80 mg
360 pills - 400/80 mg
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Product description

Pharmacological action of Bactrim

Buy Bactrim in Canada

Pharmacodynamics. Bactrim contains two active substances that have a synergistic effect, blocking two enzymes that catalyze successive steps in the biosynthesis of folic acid in microorganisms. Thanks to this mechanism, the in vitro bactericidal effect is usually achieved even at such concentrations in which individual components exhibit only a bacteriostatic effect. In addition, Bactrim is often effective against pathogens that are resistant to one of its components. The risk of developing multidrug resistance is minimized.

In vitro antibacterial action of Bactrim covers a wide range of gram-positive and gram-negative pathogenic and opportunistic microorganisms.

Pathogens are usually sensitive (sensitive MIC <80 mg / l):

cocci: Branhamella catarrhalis;

gram-negative bacilli: Haemophilus influenzae (β-lactamase-positive, β-lactamase-negative), Haemophilus parainfluenzae, E. coli, Citrobacter freundii, other Citrobacter spp., Klebsiella pneumoniae, Klebsiella aerteroxytoca, others Klebsiella spp., Enterobacae spp. , Hafnia alvei, Serratia marcescens, Serratia liquefaciens, others Serratia spp., Proteus mirabilis, Proteus vulgaris, Morganella morganii, Shigella spp., Yersinia enterocolitica, others Yersinia spp., Vibrio cholerae, Alcaligenes faeomonsecalis, p. ...

Based on clinical experience, the following pathogens have also been reported as susceptible: Brucella, Listeria monocytogenes, Nocardia asteroides, Pneumocystis carinii, Cyclospora cayetanensis.

Pathogens are partially sensitive (MIC = 80 - 160 mg / l):

cocci: Staphylococcus aureus (methicillin-sensitive and methicillin-resistant), Staphylococcus spp. (coagulase-negative), Streptococcus pneumoniae (penicillin-sensitive and penicillin-resistant);

gram-negative bacilli: Haemophilus ducrei, Providencia rettgere, other Providencia spp., Salmonella typhi, Salmonella enteritidis, Stenotrophomonas maltophilia (former Xanthomonas maltophilia), Acinetobacter lwoffi, Acinetobacter anitratumus (head)

Mycoplasma spp., Mycobacterium tuberculosis, Pseudomonas aeruginosa and Treponema pallidum are generally drug resistant.

For infections caused by partially susceptible microorganisms, it is recommended to conduct a sensitivity test to exclude possible resistance of the pathogen.

Bactrim susceptibility can be determined by standard means such as the disc method or the dilution method recommended by the National Clinical Laboratory Standards Committee (NCCLS).

Indications for use Bactrim

Packaging of the drug Bactrim

Infections of the upper and lower respiratory tract: acute and chronic bronchitis, bronchiectasis, pneumonia (including those caused by Pneumocystis carinii), pharyngitis, tonsillitis (in infections caused by b-hemolytic streptococcus group A, the frequency of eradication is not completely sufficient ), sinusitis, otitis media.

Kidney and urinary tract infections: acute and chronic cystitis, pyelonephritis, urethritis, prostatitis.

Infections of the gastrointestinal tract, including typhoid fever and paratyphoid fever, including cases of persistent carriage; bacterial dysentery, cholera (in addition to the renewal of fluid and electrolytes).

Skin and soft tissue infections: pyoderma, furunculosis, abscesses and infected wounds.

Other bacterial infections: acute and chronic osteomyelitis, acute brucellosis, septicemia caused by sensitive pathogens, nocardiosis, mycetoma (except caused by real fungi), South American blastomecosis.


Special instructions

In elderly and senile patients, as well as in patients with an existing deficiency of folic acid or renal failure, during treatment with Bactrim, hematological changes may occur, which indicate a marriage of folic acid. They disappear after folic acid administration.

Patients who are treated with Bactrim for a long time need to regularly do a general urine test and monitor kidney function.

During treatment, you need to ensure a sufficient supply of fluid into the body.

Influence on the results of laboratory tests.

Bactrim, namely trimethoprim, which is included in its composition, can affect the results of determining the concentration of methotrexate in serum, carried out by the method of competitive binding to proteins using bacterial dihydrofolate reductase as a ligand. However, when determining methotrexate by radioimmunoassay, interference does not occur.

Trimethoprim and sulfomethoxazole can also affect the results of the Jaffe reaction (determining creatinine by reaction with picric acid in an alkaline medium), while in the normal range the results are overestimated by about 10%.

Interaction

In elderly and senile patients who took at the same time some diuretics (mainly thiazides), an increased incidence of thrombocytopenia was observed.

It has been reported that in patients taking the anticoagulant warfarin, Bactrim may cause an increase in prothrombin time. The possibility of such interactions should be remembered when prescribing Bactrim to patients who are already receiving anticoagulants. In these cases, it is necessary to re-determine the time of blood clotting.

Bactrim can inhibit the hepatic metabolism of phenytoin. After the appointment of Bactrim in ordinary clinical doses, there was an increase in the half-life of phenytoin by 39% and a decrease in the rate of its metabolic clearance by 27%. When both drugs are prescribed at the same time, it is important to monitor the excessive effect of phenytoin.

Sulfonamides can also displace methotrexate from plasma protein bonds, thus increasing the concentration of free methotrexate.

There are reports of cases of pancytopenia in patients who took a combination of trimethoprim with methotrexate (see "Side Effects"). Trimethoprim has a slight relationship with cholovic dehydrofolate reductase, however, it can increase the toxicity of methotrexate and lead to the development of hematological side interactions with methotrexate, especially in the presence of other risk factors, such as old age, hypoalbuminemia, impaired renal function, and decreased bone marrow reserve. This side effect of the drug can occur especially when methotrexate is given in high doses. It is recommended that these patients be treated with folic acid or calcium folinate to avoid interfering with hematopoiesis.

Bactrim can affect the need for sugar-reducing drugs.

Some reports suggest that with the simultaneous appointment of Bactrim to patients who receive pyrimethamine for the prevention of malaria in doses of more than 25 mg per week, they may develop megaloblastic anemia.

In patients after kidney transplantation, who at the same time received trimethoprim and sulfamethoxazole and cyclosporine, there was a reversible deterioration of renal function.

Overdose

Symptoms of acute overdose: nausea, vomiting, diarrhea, headache, dizziness, intellectual and visual disturbances, in severe cases - crystalluria, hematuria and anuria.

Symptoms of chronic overdose: inhibition of hematopoiesis (thrombocytopenia, leukopenia), as well as other pathological changes in the blood picture due to folic acid deficiency.

Treatment (depending on the symptomatology): increased renal excretion by forced diuresis (alkalization of urine promotes excretion), hemodialysis (peritoneal dialysis is ineffective). It is necessary to monitor the blood picture and electrolytes. With pronounced pathological changes in the blood picture or jaundice, specific treatment is prescribed. To eliminate the effect of trimethoprim on hematopoiesis, calcium folinate can be prescribed at a dose of 3 - 6 mg IM for 5 - 7 days.

Storage

conditions Keep out of the reach of children, at a temperature not exceeding 25 ° С


Side effects

Bactrim® is usually well tolerated in the recommended doses. The most common side effects are skin rashes and gastrointestinal disturbances.

From the side of the organism as a whole

The reactions of hypersensitivity are described. As with the treatment of any other drug, patients with hypersensitivity to the components of the drug may develop allergic reactions: fever, angioedema, anaphylactoid reactions, serum sickness, and in rare cases - infiltrates in the lungs like eosinophilic or allergic alveolitis. They can clinically present with coughing and shortness of breath. In the event of a sudden appearance or increase of such symptoms, the patient should be examined and consider stopping therapy with Bactrim®. In rare cases, periarteritis nodosa and allergic myocarditis have occurred. Cases of fungal infections such as candidiasis have been reported.

In decreasing order of frequency, the following side effects can be observed.

On the part of the skin: adverse reactions are usually mild and quickly disappear after discontinuation of the drug. Like other drugs containing sulfonamides, Bactrim® in rare cases can lead to photosensitization, development of erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome) and Shenlein-Henoch purpura, drug rash with eosipophilia and systemic manifestations (DRESS syndrome).

From the gastrointestinal tract: nausea (with or without vomiting), stomatitis, diarrhea, liver necrosis, rare cases of hepatitis, cholestasis, glossitis, isolated cases of pseudomembranous enterocolitis, increased activity of hepatic transaminases and the concentration of bilirubin, isolated cases of disappearing bile duct syndrome ". Cases of acute pancreatitis during treatment with Bactrim® have been described, but several of these patients suffered from severe illnesses, including those with acquired immunodeficiency syndrome (AIDS).

On the part of the hematopoietic organs: leukopenia, neutropenia, granulocytopenia and thrombocytopenia (most often mild or asymptomatic and disappear after drug withdrawal); very rarely - agranulocytosis, anemia (megaloblastic, hemolytic / autoimmune, or aplastic), methemoglobinemia, pancytopenia, or purpura.

From the urinary system: in rare cases - impaired renal function, interstitial nephritis, increased blood urea nitrogen, serum creatinine, crystalluria. Sulfoamides, including the drug Bactrim®, can lead to increased urine output, especially in patients with cardiac edema.

From the nervous system: neuropathy (including peripheral neuritis and paresthesia), hallucinations, uveitis, rare cases of aseptic meningitis or meningeal symptoms, ataxia, seizures, systemic and non-systemic dizziness.

From the respiratory system: isolated cases of pulmonary infiltrates, similar to those that occur with eosinophilic or allergic alveolitis. They can present with symptoms such as coughing or shortness of breath. In case of a sudden appearance or increase of this symptomatology, it is necessary to re-examine the patient and consider stopping treatment with Bactrim®.

From the side of the musculoskeletal system: rarely - arthralgia and myalgia, isolated cases of rhabdomyolysis are described.

From the metabolic side: large doses of trimethoprim, used to treat Pneumocystis pneumonia, lead to a progressive but reversible increase in serum potassium in a significant number of patients. Even taking the recommended doses of trimethoprim can cause hyperkalemia if it is prescribed against a background of potassium metabolism disorders, renal failure, or the simultaneous administration of drugs that provoke hyperkalemia. Serum potassium should be monitored regularly in these patients. Cases of hyponatremia have been described. In persons without diabetes mellitus and receiving trimethoprim-sulfamethoxazole, cases of hypoglycemia are occasionally observed, usually a few days after starting treatment. The risk of hypoglycemia is higher in patients with impaired renal function, liver disease, malnutrition, or receiving large doses of trimethoprim-sulfamethoxazole.

Adverse reactions in patients with AIDS. The incidence of side effects, especially rash, fever, leukopenia, and increased serum hepatic aminotransferase activity in AIDS patients, is significantly higher than that in non-AIDS patients.