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Sulfamethoxazole and trimethoprim are used in combination as co-trimoxazole because of their synergistic activity the importance of the sulfonamides has decreased as a result of increasing bacterial resistance and their replacement by antibacterials which are generally more active and less toxic. Co-trimoxazole may be used as detailed below, although these situations are considered unlicensed Stenotrophomonas maltophilia has demonstrated susceptibility to co-trimoxazole. It should only be considered for use in acute exacerbations of chronic bronchitis and infections of the urinary tract when there is bacteriological evidence of sensitivity to co-trimoxazole and good reason to prefer this combination to a single antibacterial; similarly it should only be used in acute otitis media in children when there is good reason to prefer it. Asthma; avoid in blood disorders unless under specialist supervision ; avoid in infants under 6 weeks except for treatment or prophylaxis of pneumocystis pneumonia because of the risk of kernicterus; elderly increased risk of serious side-effects in adults ; G6PD deficiency risk of haemolytic anaemia ; maintain adequate fluid intake; predisposition to folate deficiency; predisposition to hyperkalaemia. Co-trimoxazole is associated with rare but serious side effects.

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