As I finished writing on deadly drug combinations yesterday (or last week or last month, depending on when this posts), I was putting together the list of related articles and looked for an article on SMZ-TMP to link, as it is something to be avoided if on spironolactone. I had a sneaking suspicion that I’d never written on it. And I was right. So it’s now time to rectify.
How could I have missed writing on this common antibiotic for so long? Dr. Koelker, author of Armageddon Medicine, ranks it in the top 5 of antibiotics to stockpile.[1] It’s one of the most inexpensive antibiotics sold by All Day Chemist. Before our ever-benevolent FDA took action, it was available as a “fish” antibiotic. Dr. Joseph Alton addresses it in his Alton’s Antibiotics handbook.
SMZ-TMP, also known as SMX-TMP as well as TMP-SMX/Z, is a sulfonamide, one of the bacteriostatic antibiotics. It’s a combination of sulfamethoxazole (the SMZ or SMX component) and trimethoprim (the TMP). Sold as Bactrim or Septra in the US, it comes in two strengths, regular (400 mg/80 mg) and double strength (Bactrim DS or Septra DS, 800 mg/160 mg). The “fish” equivalent is Fish-Sulfa Forte. Each of the components is an antibiotic in its own right; studies show that the combination is stronger in effect than when taken separately. This broad-spectrum antibiotic is also rather effective against MRSA infections.[2]
All the dosages below are for using the DS tablets, since these are much more commonly prescribed. When purchasing SMZ-TMP, just get the DS tablets and the split them later if needed for use in children.[3]
USAGE
· Gastrointestinal, one 800 mg/160 mg tablet by mouth every 12 hours for 5 days[4]
o Dysentery[5]
o E. coli infections[6]
o Shigella infections[7]
o Traveler’s diarrhea[8]
· Respiratory
o Bronchitis due to Haemophilus influenzae or Streptococcus pneumoniae
§ One 800 mg/160 mg tablet by mouth every 12 hours for 2 weeks[9]
o Ear infection (otitis media)
§ One 800 mg/160 mg tablet by mouth every 12 hours for 10-14 days[10]
o Sinus headache, if accompanied by thick mucus congestion, low fever, and cough
§ One 800 mg/160 mg tablet by mouth every 12 hours for 1 week[11]
o Sinusitis
§ One 800 m/160 mg tablet by mouth every 12 hours for 2-4 weeks[12]
· Skin
o Acne, severe cases
§ One 800 mg/160 mg tablet by mouth every 12 hours for 2 weeks[13]
o Cellulitis
§ One 800 mg/160 mg tablet by mouth every 12 hours for 7-10 days[14]
· Urogenital
o Bladder infection
§ One 800 mg/160 mg tablet by mouth every 12 hours for 10-14 days[15]
o Kidney infection
§ One 800 mg/160 mg tablet by mouth every 12 hours for 10-14 days[16]
The dosage for children with ear infections or urinary tract infections is 40 mg/kg SMZ and 8 mg/kg TMP (you’ll have to do the math, sorry) in two divided doses every 12 hours for 10 days. [17]
Side effects: Skin rash, hives, diarrhea, nausea, vomiting. [18]
Cautions: Not for use in infants under the age of 2 months. [19] Not for use in pregnant or nursing women. It has been shown that this drug causes birth defects in rats. [20]
[1] https://survivalblog.com/2011/02/18/seven-antibiotics-to-stockpile/
[2] Survival and Austere Medicine, 3rd Edition, 2017, 211.
[3] Cynthia Koelker, Armageddon Medicine, 2012, 441.
[4] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[5] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[6] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[7] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[8] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[9] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[10] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[11] Joseph Alton, et al., Survival Medicine Handbook, 4th Edition, 2021, 187.
[12] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[13] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[14] Joseph Alton, et al., Survival Medicine Handbook, 4th Edition, 2021, 376.
[15] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[16] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[17] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[18] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[19] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
[20] Joseph Alton, et al., Alton’s Antibiotics, 2018, 166.
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