Trimethoprim-Sulfamethoxazole (TMP-SMX; TMP-SMZ)

Mixture of 5 parts of Sulfamethoxazole and 1 part of Trimethoprim. Oral administration in two daily doses.

TRIMETHOPRIM (TMP) is excreted in breast milk in clinically non-significant amount ^{(Borderon 1975, Miller 1974 y 1973, Arnauld 1972)}. No problems have been observed in infants whose mothers were treated ^{(Ito 1993)}. Medication which is used in infants from the second month of age.

SULFAMETHOXAZOLE (SMX) is excreted in non-significant levels into breast milk ^{(Miller 1974 y 1973)}. No adverse effects have been shown in breastfed infants ^{(Ito 1993)}. Caution with those neonates suffering of hyperbilirrubinemia or Glucose-6-phosphate dehydrogenase (G6PD) deficiency is required. Avoid use in affected patients Check-up for infant jaundice.

Although rare, the possibility of transient gastroenteritis due to alteration of the intestinal flora in infants whose mothers take antibacterial should be taken into account.^{(Ito 1993)}

Expert authors consider the use of TMP-SMX to be compatible during breastfeeding. ^{(Hale, LactMed, Schaefer2015, Mitrano 2009, Kaiser 2007, Chin 2001)}

The American Academy of Pediatric states that TMP-SMX is usually compatible with breastfeeding medication. ^{(AAP 2001)}

WHO List of Essential Medicines from 2002 has classified TMP as compatible with breastfeeding and  SMX as compatible with breastfeeding for older, healthy full- term infants. Avoid if possible if the infant is premature or less than 1 month old. Monitor the infant for side- effects (haemolysis and jaundice). Avoid in infant with G6PD deficiency. ^{(OMS-UNICEF 2002)}

See below the information of these related products:

• Sulfamethoxazole (SMX, SMZ) (Safe substance and/or breastfeeding is the best option.)
• Trimethoprim (TMP) (Safe substance and/or breastfeeding is the best option.)