On-call scenario 3: Introduction

Last updated: Wednesday, June 05, 2024

 Hi, it’s one of the doctors in medicine. I’ve got a patient who needs IV co-trimoxazole. They’re currently fluid restricted, so I wanted some advice on how the co-trimoxazole dose should be diluted please?"

You ask a few further questions and get the following information…

Caller: Jack Cohen, FY1, ext. 7056.

Patient: Mary Dodd, hospital no. 1659982, age 60 years.

Medicines: IV co-trimoxazole 4.4g QDS. Also prescribed furosemide, ramipril, bisoprolol and omeprazole.

Clinical problem: Patient is being treated for pneumocystis pneumonia (PCP/PJP). The microbiology team have suggested using IV co-trimoxazole 120mg/kg in divided doses, and the patient weighs 147kg. The patient has a history of heart failure and is overloaded, so the doctor is concerned about the volume of fluid needed to administer IV co-trimoxazole. The patient has a single lumen peripheral line in situ. 

Renal and liver function are okay.
You tell the doctor that you will look into it and then call them back shortly.
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