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The use of nitrofurantoin is contraindicated in patients with an estimated GFR of less than 30 mL/min/1.73m 2 as drug accumulation can lead to increased side effects and impaired recovery of the urinary tract, increasing the risk of treatment failure. [29] The use of TMP/SMX also raises concerns in patients with kidney disease.
Symptoms of a kidney infection, on the other hand, are more systemic and include fever or flank pain usually in addition to the symptoms of a lower UTI. [10] Rarely, the urine may appear bloody. [7] Symptoms may be vague or non-specific at the extremities of age (i.e. in patients who are very young or old). [1] [11]
It is one of the few drugs commonly used in pregnancy to treat UTIs. [38] There is a potential risk of hemolytic anemia in the newborn when used near time of delivery. [3] Newborns of women given this drug late in pregnancy had a higher risk of developing neonatal jaundice. [39] Evidence of safety in early pregnancy is mixed as of 2017. [40]
Sulfamethoxazole (SMZ or SMX) is an antibiotic.It is used for bacterial infections such as urinary tract infections, bronchitis, and prostatitis and is effective against both gram negative and positive bacteria such as Escherichia coli and Listeria monocytogenes.
The following is a list of antibiotics. The highest division between antibiotics is bactericidal and bacteriostatic. Bactericidals kill bacteria directly, whereas bacteriostatics prevent them from dividing. However, these classifications are based on laboratory behavior.
The effects of trimethoprim causes a backlog of dihydrofolate (DHF) and this backlog can work against the inhibitory effect the drug has on tetrahydrofolate biosynthesis. This is where the sulfamethoxazole comes in; its role is in depleting the excess DHF by preventing it from being synthesised in the first place.
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