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Cotrimoxazole, a combined drug consisting of 1 part of trimethoprim and 5 part of sulfamethoxazole, was introduced into clinical practice about 30 years ago and is still widely prescribed for various indications. A combination of trimethoprim-sulfamethoxazole is effective treatment for a wide variety of infections including P jiroveci pneumonia, shigellosis, systemic salmonella infections, urinary tract infections, prostatitis, and some nontuberculous mycobacterial infections. Trimethoprim in combination with a sulfonamide blocks sequential steps in folate synthesis, resulting in marked enhancement (synergism) of the activity of both drugs. The combination often is bactericidal, compared with the bacteriostatic activity of a sulfonamide alone.
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