Johns Hopkins ABX Guide
Trimethoprim + Sulfamethoxazole
INDICATIONS
FDA
FDA
- Traveler’s diarrhea
- Shigellosis
- Otitis media (with documented sensitive S. pneumoniae)
- AECB
- Due to susceptible strains of Haemophilus influenzae or Streptococcus pneumoniae.
- Pneumocystis jiroveci pneumonia (PCP, treatment and prophylaxis)
- Urinary tract infections
- uUTIs due to Escherichia coli, Klebsiellaand Enterobacter spp, Morganella morganii, Proteus mirabilis, and Proteus vulgari.
- Severe or complicated UTIs due to E. coli, Klebsiella and Enterobacter spp, M. morganii, P. mirabilis,and P. vulgaris.
- Microbiologic indications (per prescribing information): likely active against most strains; however, increasing resistance seen for some spp. e.g., Klebsiella and Enterobacter. Check susceptibility profiles.
- Aerobic Gram-positive microorganisms:
- Aerobic Gram-negative microorganisms:
- Escherichia coli (including susceptible enterotoxigenic strains implicated in traveler’s diarrhea)
- Klebsiella species
- Enterobacter species
- Haemophilus influenza
- Morganella morganii
- Proteus mirabilis
- Proteus vulgaris
- Shigella flexneri
- Shigella sonnei
- Other Organisms:
NON-FDA APPROVED USES
NON-FDA APPROVED USES
- There are many off-label uses; the list is not comprehensive.
- Nocardia
- Toxoplasmosis (treatment and prophylaxis)
- Bacterial cystitis prophylaxis
- Isospora infections
- Salmonella
- MSSA and MRSA infections
- Legionella (second line)
- Listeria treatment (second-line for PCN-allergic patients, including meningitis)
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Last updated: October 8, 2023
Citation
Auwaerter, Paul G, and Kathryn Dzintars. "Trimethoprim + Sulfamethoxazole." Johns Hopkins ABX Guide, The Johns Hopkins University, 2023. Johns Hopkins Guides, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540565/all/Trimethoprim_+_Sulfamethoxazole.
Auwaerter PG, Dzintars K. Trimethoprim + Sulfamethoxazole. Johns Hopkins ABX Guide. The Johns Hopkins University; 2023. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540565/all/Trimethoprim_+_Sulfamethoxazole. Accessed October 30, 2025.
Auwaerter, P. G., & Dzintars, K. (2023). Trimethoprim + Sulfamethoxazole. In Johns Hopkins ABX Guide. The Johns Hopkins University. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540565/all/Trimethoprim_+_Sulfamethoxazole
Auwaerter PG, Dzintars K. Trimethoprim + Sulfamethoxazole [Internet]. In: Johns Hopkins ABX Guide. The Johns Hopkins University; 2023. [cited 2025 October 30]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540565/all/Trimethoprim_+_Sulfamethoxazole.
* Article titles in AMA citation format should be in sentence-case
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T1 - Trimethoprim + Sulfamethoxazole
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A1 - Auwaerter,Paul,M.D.
AU - Dzintars,Kathryn,Pharm.D., BCPS
Y1 - 2023/10/08/
BT - Johns Hopkins ABX Guide
UR - https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540565/all/Trimethoprim_+_Sulfamethoxazole
PB - The Johns Hopkins University
DB - Johns Hopkins Guides
DP - Unbound Medicine
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