Verify Trimethoprim-Sulfamethoxazole

Drug JSON

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{
  "slug": "tmp-smx",
  "nameEn": "Trimethoprim-Sulfamethoxazole",
  "nameTh": "ไตรเมโทพริม-ซัลฟาเมทอกซาโซล",
  "class": "Antibiotic — potentiated sulfonamide (trimethoprim + sulfonamide)",
  "mechanism": "ยาผสมที่ยับยั้งการสร้าง folate ของแบคทีเรียแบบต่อเนื่อง 2 จุด: sulfonamide ยับยั้ง dihydropteroate synthase และ trimethoprim ยับยั้ง dihydrofolate reductase จึงออกฤทธิ์ bactericidal เมื่อใช้ร่วมกัน; ครอบคลุมเชื้อกว้างและโปรโตซัว (เช่น coccidia)",
  "brandNamesTh": [
    "Bactrim",
    "Septra",
    "Tribrissen",
    "Co-trimoxazole"
  ],
  "indications": [
    {
      "text": "ติดเชื้อแบคทีเรียวงกว้าง (ทางเดินปัสสาวะ ทางเดินหายใจ ผิวหนัง ต่อมลูกหมาก) และโรคโปรโตซัวบางชนิด เช่น coccidiosis",
      "cites": [
        "who-eml-22",
        "dailymed-tmp-smx"
      ]
    }
  ],
  "contraindications": [
    {
      "text": "ห้ามใช้ในสัตว์ที่แพ้ sulfonamide, มีภาวะตับ/ไตบกพร่องรุนแรง, เกล็ดเลือดต่ำ หรือโรคเลือด; ระวังในพันธุ์ Doberman (เสี่ยงแพ้ sulfonamide สูง)",
      "cites": [
        "dailymed-tmp-smx"
      ]
    }
  ],
  "sideEffects": [
    {
      "text": "⚠️ ในสุนัข: สัมพันธ์กับการเกิดภาวะตาแห้ง (keratoconjunctivitis sicca, KCS) โดยเฉพาะเมื่อใช้นาน — เฝ้าระวังตาแดง ขี้ตามาก กระพริบตาถี่ หรือหรี่ตา; อาการอื่น: อาเจียน เบื่ออาหาร ถ่ายเหลว น้ำลายไหล, ภาวะภูมิแพ้ และผลต่อเลือด",
      "cites": [
        "jvim-tms-kcs",
        "dailymed-tmp-smx"
      ]
    }
  ],
  "dosages": [
    {
      "species": "canine",
      "indication": "Bacterial infection",
      "route": "PO",
      "dose": "15 mg/kg (รวม trimethoprim + sulfonamide) ทุก 12 ชั่วโมง",
      "notes": "⚠️ ตรวจสอบขนาดยาในตำราเฉพาะทาง (Plumb's) ก่อนใช้จริง; เฝ้าระวัง KCS เมื่อใช้นาน — ตรวจ tear production (Schirmer) เป็นระยะ",
      "cites": [
        "dailymed-tmp-smx",
        "jvim-tms-kcs"
      ]
    }
  ],
  "citations": [
    {
      "id": "jvim-tms-kcs",
      "type": "paper",
      "title": "Development of keratoconjunctivitis sicca in dogs treated with trimethoprim-sulfonamide: a VetCompass Australia study",
      "year": 2026,
      "url": "https://academic.oup.com/jvim/article/40/1/aalaf013/8429714",
      "note": "Peer-reviewed (J Vet Intern Med) evidence linking TMS to KCS (dry eye) in dogs. Cited for the KCS warning.",
      "cid": null
    },
    {
      "id": "wikipedia-Co-trimoxazole",
      "type": "monograph",
      "title": "Co-trimoxazole — Wikipedia",
      "year": 2026,
      "url": "https://en.wikipedia.org/wiki/Co-trimoxazole",
      "note": "Tertiary cross-check for class, mechanism, brand names. CC BY-SA 4.0. Not sole authority for any clinical claim.",
      "cid": null
    },
    {
      "id": "dailymed-tmp-smx",
      "type": "regulatory-database",
      "title": "Trimethoprim-Sulfamethoxazole — NLM DailyMed (FDA Structured Product Labeling)",
      "year": 2025,
      "url": "https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=tmp-smx",
      "note": "Cross-checked source: FDA-approved labeling. Search by name returns relevant product labelings.",
      "cid": "077dd26cdc9f970df1b46cf6fd223e98e9a2c4a45ed175d679a5d3c561b88637"
    },
    {
      "id": "atc-J01EE01",
      "type": "guideline",
      "title": "ATC J01EE01 — Trimethoprim and sulfamethoxazole (Co-trimoxazole)",
      "year": 2025,
      "url": "https://www.whocc.no/atc_ddd_index/?code=J01EE01&showdescription=no",
      "note": "Cross-checked source: WHO Collaborating Centre ATC/DDD index. Authoritative drug classification.",
      "cid": "ef5dee5e668ea3e55d6540da9598826e64ffbf830f2639a9941d3ab257b702e2"
    },
    {
      "id": "pubchem-tmp-smx",
      "type": "monograph",
      "title": "Trimethoprim-Sulfamethoxazole — PubChem search",
      "year": 2025,
      "url": "https://pubchem.ncbi.nlm.nih.gov/#query=Trimethoprim-Sulfamethoxazole",
      "note": "Cross-checked source: chemical structure, identifiers, pharmacology summary. Faculty review fills exact CID.",
      "cid": "726b1a4986e9597a052a8beeaf1bc7e351cae0a3474c2afc252a27ba48f426b4"
    },
    {
      "id": "who-eml-22",
      "type": "guideline",
      "title": "WHO Model List of Essential Medicines (22nd List, 2021)",
      "year": 2021,
      "url": "https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02",
      "note": "Cross-checked source: drug appears on WHO EML — WHO recognizes its place in basic healthcare.",
      "cid": "71030c795c4e0c0cff56566bfc9ae4ed448eab9188ae68ce773a50d9f7fc53eb"
    },
    {
      "id": "wsava-amr-2023",
      "type": "guideline",
      "title": "WSAVA Therapeutic Guidelines Group — Library on Responsible Antimicrobial Use and AMR Prevention (2023)",
      "year": 2023,
      "url": "https://wsava.org/wp-content/uploads/2023/05/WSAVA-TGG-library-on-responsible-antimicrobial-use-and-AMR-prevention-2.pdf",
      "note": "Cross-checked source: WSAVA TGG framework for prudent antibiotic use in companion animals (PDF, stable URL).",
      "cid": "29f7ea6edf16004626349e036f3eb2ea30803ca1f6efd437bff0e8a4f2f465f1"
    }
  ],
  "mirroredFrom": [
    {
      "id": "dailymed",
      "name": "NLM DailyMed",
      "url": "https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=tmp-smx",
      "asOfDate": "2026-05-27",
      "license": "U.S. Government work — public domain. Attribution recommended."
    },
    {
      "id": "atc",
      "name": "WHO ATC Classification",
      "url": "https://www.whocc.no/atc_ddd_index/?code=J01EE01&showdescription=no",
      "asOfDate": "2026-05-27",
      "license": "WHO publication, free for use with attribution"
    },
    {
      "id": "pubchem",
      "name": "PubChem (NIH/NLM)",
      "url": "https://pubchem.ncbi.nlm.nih.gov/#query=Trimethoprim-Sulfamethoxazole",
      "asOfDate": "2026-05-27",
      "license": "NIH/NLM public domain"
    },
    {
      "id": "who-eml",
      "name": "WHO Model List of Essential Medicines (22nd List, 2021)",
      "url": "https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2021.02",
      "asOfDate": "2026-05-27",
      "license": "CC BY-NC-SA 3.0 IGO"
    },
    {
      "id": "wsava-amr",
      "name": "WSAVA TGG — Key Documents on Responsible Antimicrobial Use and AMR Prevention",
      "url": "https://wsava.org/wp-content/uploads/2023/05/WSAVA-TGG-library-on-responsible-antimicrobial-use-and-AMR-prevention-2.pdf",
      "asOfDate": "2026-05-27",
      "license": "Free for educational use with attribution"
    }
  ],
  "mirrorCIDs": [
    {
      "sourceId": "dailymed",
      "cid": "077dd26cdc9f970df1b46cf6fd223e98e9a2c4a45ed175d679a5d3c561b88637",
      "capturedAt": "2026-05-27",
      "status": "stub"
    },
    {
      "sourceId": "atc",
      "cid": "ef5dee5e668ea3e55d6540da9598826e64ffbf830f2639a9941d3ab257b702e2",
      "capturedAt": "2026-05-27",
      "status": "stub"
    },
    {
      "sourceId": "pubchem",
      "cid": "726b1a4986e9597a052a8beeaf1bc7e351cae0a3474c2afc252a27ba48f426b4",
      "capturedAt": "2026-05-27",
      "status": "stub"
    },
    {
      "sourceId": "who-eml",
      "cid": "71030c795c4e0c0cff56566bfc9ae4ed448eab9188ae68ce773a50d9f7fc53eb",
      "capturedAt": "2026-05-27",
      "status": "stub"
    },
    {
      "sourceId": "wsava-amr",
      "cid": "29f7ea6edf16004626349e036f3eb2ea30803ca1f6efd437bff0e8a4f2f465f1",
      "capturedAt": "2026-05-27",
      "status": "stub"
    }
  ],
  "codes": {
    "atc": {
      "code": "J01EE01",
      "name": "Trimethoprim and sulfamethoxazole (Co-trimoxazole)",
      "level": 5
    },
    "rxnorm": {
      "cui": "10180",
      "name": "Trimethoprim and sulfamethoxazole"
    }
  },
  "drafting": {
    "aiAssisted": false,
    "aiModel": null,
    "aiPromptHash": null,
    "humanReviewer": "palmzamak2547",
    "humanReviewedAt": "2026-05-27",
    "humanEditsRatio": null
  },
  "signatures": [],
  "reviewedBy": null,
  "lastUpdated": "2026-05-27",
  "version": 1,
  "changelog": [
    {
      "version": 0,
      "date": "2026-05-27",
      "summary": "Seed entry — cross-checked from 5 authoritative sources (NLM DailyMed, WHO ATC Classification, PubChem (NIH/NLM), WHO Model List of Essential Medicines (22nd List, 2021), WSAVA TGG — Key Documents on Responsible Antimicrobial Use and AMR Prevention). ATC J01EE01 + RxNorm 10180. Thai translation + faculty review pending."
    },
    {
      "version": 1,
      "date": "2026-05-27",
      "summary": "Clinical content compiled from cited sources — dog 15 mg/kg q12h with KCS (dry eye) monitoring warning from peer-reviewed JVIM VetCompass study + FDA label. Dose flagged for Plumb's faculty confirmation. Every statement cited. Reviewed by palmzamak2547. Pending faculty canonical signature."
    }
  ],
  "monitoring": [
    {
      "text": "ตรวจการสร้างน้ำตา (Schirmer tear test) เป็นระยะเมื่อใช้ยานาน; เฝ้าระวังภาวะเลือด (CBC) เมื่อใช้ระยะยาว",
      "cites": [
        "jvim-tms-kcs"
      ]
    }
  ]
}

Public keys used

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