트리메토프림/설파디아진 및 트리메토프림/설파메톡사졸
Sulfadiazine/Trimethoprim and Sulfamethoxazole/Trimethoprim
Trimethoprim/Sulfadiazine, Trimethoprim/Sulfamethoxazole
다른 이름: Co-trimoxazole · Tribrissen · Bactrim · Septra · Tucoprim · Uniprim · Di-Biotic · Cotrim · Sulfatrim · Trivetrin · Borgal · SMX-TMP · trimethoprim-sulfamethoxazole · sulfadiazine-trimethoprim · TMP-SDZ · Co-trimazine
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
구조화 용량 계산 근거Coccidiosis
- q12-24h
NA
반드시 함께 고려할 임상 맥락 (3)
- NOTE: There is significant controversy regarding the frequency of administration of these drugs. See Pharmacokinetics for more information. Unless otherwise noted, doses are for combined sulfa-/trimethoprim. See Monitoring if treatment is expected to be longer than 7 days.
- Bacterial cystitis (extra-label): Potentiated sulfonamides (ie, sulfa-/ trimethoprim, sulfadimethoxine/ormetoprim) are first-tier drugs only if regional pathogen susceptibility patterns are known. 32
- Unless otherwise instructed by the manufacturer, sulfa-/trimethoprim products should be stored at room temperature of 20°C to 25°C (68°F-77°F) in tight containers and protected from freezing. Shake suspensions well before use.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
강화 설파제(흔히 TMS, SMZ-TMP 또는 코트리목사졸로 불림)는 수의학에서 광범위하게 사용되는 광범위 살균성 항균 복합제입니다.
주요 임상 요점:
- 우수한 조직 침투력: 지용성이 높아 전립선, 혈액뇌장벽(CNS), 눈과 같이 침투하기 어려운 조직에서도 치료 농도에 도달할 수 있습니다.
- 광범위 스펙트럼: 메티실린 내성 포도상구균(MRSA/MRSP)의 많은 균주, 노카르디아, 특정 원충(톡소플라스마, 콕시듐, 폐포자충)을 포함한 많은 그람 양성 및 음성균에 효과적입니다.
- 농에 의한 불활성화: 약효는 화농성 잔해물과 괴사 조직(PABA와 티미딘이 풍부함)에 의해 크게 억제됩니다. 약효를 발휘하려면 농양을 배농해야 합니다.
- 품종 민감성: 도베르만 핀셔는 설파제 유발 다계통 면역 복합체 질환(과민 반응)에 대한 품종 특이적 감수성이 있는 것으로 알려져 있습니다.
- 제형: 수의용으로 승인된 트리메토프림/설파디아진 제품이 있지만, 많은 수의사들이 인체용으로 승인된 트리메토프림/설파메톡사졸(Bactrim®, Septra®)을 허가 외(off-label)로 사용하여 유사한 효과를 얻고 있습니다.
작용 기전
Potentiated sulfas exhibit synergistic, bactericidal activity by sequentially blocking the bacterial folic acid synthesis pathway. Mammalian cells are largely unaffected because they utilize preformed dietary folate rather than synthesizing it.
- Sulfonamides (Bacteriostatic alone): Act as structural analogues of para-aminobenzoic acid (PABA). They competitively inhibit the bacterial enzyme dihydropteroate synthase → blocks the conversion of PABA to dihydrofolic acid (DFA).
- Trimethoprim (Bactericidal alone): Reversibly inhibits the bacterial enzyme dihydrofolate reductase → blocks the conversion of DFA to tetrahydrofolic acid (THFA).
- Synergy: The sequential blockade completely depletes THFA, an essential cofactor for bacterial DNA and RNA synthesis, leading to rapid bacterial cell death.
Pharmacologic Note: The optimal in vitro ratio for most susceptible bacteria is 1:20 (trimethoprim:sulfa), but synergistic activity occurs across a wide range (1:1 to 1:40). The serum concentration of the trimethoprim component is generally considered the primary driver of efficacy.
안전성·주의사항
금기사항
- Hypersensitivity to sulfonamides, thiazides, or sulfonylurea agents
- Severe renal or hepatic impairment
- Doberman pinschers (highly susceptible to immune complex disease)
- Marked blood dyscrasias
- Animals intended for food (in the USA/certain jurisdictions)
부작용
- Dogs: Keratoconjunctivitis sicca (KCS/dry eye - potentially irreversible)
- Dogs: Hypersensitivity reactions (Type 1 anaphylaxis or Type 3 serum sickness, polyarthritis, urticaria, facial swelling)
- Dogs: Acute neutrophilic hepatitis with icterus, idiosyncratic hepatic necrosis
- Dogs: Vomiting, anorexia, diarrhea
- Dogs: Hemolytic anemia, agranulocytosis
- Dogs: Hypothyroidism (with extended therapy)
- Dogs: Crystalluria, hematuria, polyuria, polydipsia
- Cats: Anorexia, crystalluria, hematuria, leukopenias, anemias
- Horses: Transient pruritus (after IV injection), diarrhea, hypersensitivity, hematologic effects
- Injection site reactions: Swelling, pain, tissue damage (IM, SC, or extravasation)
주의
Use with caution in patients with pre-existing hepatic or renal disease. Because of its potential for crystallization in the urine, avoid use in dogs known to have uroliths, at increased risk for developing uroliths, or those with highly concentrated (dehydrated) or acidic urine. Potentially teratogenic (cleft palate reported); weigh risk vs. benefit in pregnant animals. Use with caution in nursing animals as sulfonamides are excreted in milk and may cause kernicterus in neonates.
약물 상호작용
May cause toxic delirium (reported in humans)
May decrease the bioavailability of sulfonamides if administered concurrently
May increase the risk of nephrotoxicity
May increase digoxin levels
May increase risk for thrombocytopenia
May potentiate hypoglycemic effects
May displace from plasma proteins and increase risk for toxic effects; can also interfere with MTX assays
May increase half-life of phenytoin
May decrease efficacy of the antidepressant
May prolong INR/PT and increase bleeding risk
모니터링
- Clinical efficacy
- Adverse effects (GI, hypersensitivity)
- Complete blood counts (CBC) periodically with chronic therapy
- Schirmer Tear Test (STT) in dogs to monitor tear production (e.g., at 5 days, then every 2-3 weeks)
- Thyroid function tests (baseline and ongoing) for dogs on long-term treatment
약동학
반감기
흡수
Well absorbed after oral administration, with peak levels occurring about 1-4 hours after dosing. More slowly absorbed after subcutaneous administration. In ruminants >8 weeks old, trimethoprim is trapped in the ruminoreticulum after oral administration and undergoes degradation.
분포
Well distributed in the body. Enters CSF at about 50% of serum levels when meninges are inflamed. Crosses the placenta and distributes into milk. Relatively well distributed into the prostate. Volume of distribution for trimethoprim: 1.49 L/kg (dogs), 0.59-1.51 L/kg (horses). Vd for sulfadiazine in dogs is 1.02 L/kg.
대사
Metabolized by the liver. Sulfas are primarily acetylated and conjugated with glucuronic acid. Trimethoprim is metabolized to oxide and hydroxylated metabolites. Trimethoprim may be more extensively metabolized in the liver in adult ruminants.
배설
Renally excreted unchanged via glomerular filtration and tubular secretion, as well as hepatic metabolism. Trimethoprim is rapidly eliminated from serum but may persist longer in tissues.
과다투여
Manifestations of acute overdosage include GI distress (nausea, vomiting, diarrhea), CNS toxicity (depression, headache, confusion), facial swelling, bone marrow depression, and elevated serum aminotransferases.
Treatment:
- Oral Overdose: Empty the stomach following usual protocols and initiate symptomatic/supportive therapy.
- Fluid Therapy: Maintain hydration. Acidification of urine may increase renal elimination of trimethoprim but increases the risk of sulfonamide crystalluria (especially with sulfadiazine).
- Monitoring: Monitor complete blood counts and liver parameters.
- Bone Marrow Suppression: If severe and associated with chronic overdose, may be treated with folinic acid (leucovorin).
- Note: Peritoneal dialysis is not effective in removing TMP or sulfas from circulation.
제품
제형
- Oral Paste
- Sterile Injection
- Oral Powder
- Oral Tablets
- Oral Suspension
동물용의약품
- Trimethoprim/Sulfadiazine Oral Paste: 67 mg TMP / 333 mg SDZ per gram (Tribrissen 400 Oral Paste)
- Trimethoprim/Sulfadiazine Sterile Injection: 48% (Di-Biotic 48%, Tribrissen 48% Injection)
- Trimethoprim/Sulfadiazine Powder: 67 mg TMP / 333 mg SDZ per gram (Tucoprim, Uniprim)
- Trimethoprim/Sulfadoxine (Canada): Trivetrin, Borgal
인용의약품
- Trimethoprim Tablets: 100 mg, 200 mg (Proloprim, Trimpex)
- Trimethoprim/Sulfamethoxazole (TMP-SMZ) Tablets: 80 mg TMP / 400 mg SMX (Bactrim, Septra)
- Trimethoprim/Sulfamethoxazole Double Strength (DS) Tablets: 160 mg TMP / 800 mg SMX (Bactrim DS, Septra DS)
- Trimethoprim/Sulfamethoxazole Oral Suspension: 8 mg TMP / 40 mg SMX per mL (Septra, Cotrim Pediatric, Sulfatrim)
- Trimethoprim/Sulfamethoxazole Injection: 16 mg TMP / 80 mg SMX per mL
규제 현황
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보관·안정성
Unless otherwise instructed by the manufacturer, trimethoprim/sulfadiazine and co-trimoxazole products should be stored at room temperature (15-30°C) in tight containers.
보호자 정보
반려동물 보호자를 위한 중요 안내:
- 수분 공급이 중요합니다: 이 약을 복용하는 동안 반려동물이 항상 신선한 물을 충분히 마실 수 있도록 해주세요. 탈수 상태가 되면 신장이나 소변에 약물 결정이 생길 수 있습니다.
- 눈 상태 관찰(반려견): 이 약은 눈물 분비량을 감소시켜 "안구건조증"(건성 각결막염)을 유발할 수 있습니다. 반려견이 눈을 가늘게 뜨거나, 눈을 비비거나, 충혈되거나, 끈적한 노란색/녹색 눈곱이 끼는 것을 발견하면 즉시 수의사에게 연락하세요.
- 알레르기 반응: 도베르만 핀셔와 일부 대형견은 알레르기 반응이 나타나기 쉽습니다. 얼굴 부종, 두드러기, 원인 불명의 발열, 관절 뻣뻣함/절뚝거림, 또는 눈/잇몸의 황달이 관찰되면 약 투여를 중단하고 수의사에게 연락하세요.
- 투여 방법: 음식과 함께 또는 빈속에 먹일 수 있습니다. 액상 현탁액을 사용하는 경우, 매번 약을 뽑기 전에 충분히 흔들어 주세요. 액상 약은 냉장 보관할 필요가 없습니다.
- 끝까지 복용하기: 반려동물이 완전히 다 나은 것처럼 보이더라도, 항생제 내성을 예방하기 위해 반드시 수의사의 지시에 따라 처방된 약을 끝까지 먹이셔야 합니다.
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