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Last Updated: April 18, 2026

CLINICAL TRIALS PROFILE FOR SULFAMETHOXAZOLE; TRIMETHOPRIM


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505(b)(2) Clinical Trials for Sulfamethoxazole; Trimethoprim

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Combination NCT03431168 ↗ A Novel Regimen to Prevent Malaria and STI in Pregnant Women With HIV Active, not recruiting University of Alabama at Birmingham Phase 2 2018-03-07 More than 3 billion people worldwide are at risk of acquiring malaria and pregnant women living with HIV in Africa are at particular risk. An effective prophylaxis regimen capable of preventing malaria and other common perinatal infections would have great potential to improve adverse birth outcomes. The purpose of this randomized controlled trial is to evaluate a new combination prophylaxis regimen in pregnant women with HIV in Cameroon to determine its efficacy and safety.
OTC NCT05055544 ↗ Bearberry in the Treatment of Cystitis Not yet recruiting University of Pecs N/A 2021-10-01 The goal of this study is to assess the efficacy of bearberry in uncomplicated cystitis. Uncomplicated cystitis is a disease related to the infection of the urinary bladder. Typical symptoms are dysuria, urinary urgency, and frequent voiding of small volumes. Urinary tract infections are frequent in women, usually treated with antibiotics, since the disease is usually caused by bacteria. Fosfomycin is a frequently used antibiotic for the treatment of uncomplicated cystitis. This medicine is typically prescribed by MDs. However, since uncomplicated cystitis is quite frequent, not all patients visit the doctor when experiencing the symptoms of this disease. The use of over-the-counter products (medicines and food supplements) to alleviate the symptoms is common. One of the most frequently used medicinal plants for this purpose is bearberry. Bearberry is a medicinal plant traditionally used for the treatment of cystitis. Its use is accepted by the European Medicine Agency as traditional herbal medicinal product for relief of symptoms of mild recurrent lower urinary tract infections such as burning sensation during urination and/or frequent urination in women. Although the experience gained during the traditional use and the laboratory experiments support the supposed beneficial effect of bearberry, its clinical efficacy has not been confirmed in well-designed clinical trials in comparison with standard antibiotic therapy. In this study, the efficacy of bearberry will be assessed in comparison with fosfomycin. Premenopausal women experiencing the symptoms of uncomplicated cystitis will be randomly divided into two groups. Since it will be a double-blind trial, neither the participants nor the experimenters will know who is receiving a particular treatment. In group A, patients will receive a single dose of fosfomycin powder dissolved in water and 2 placebo tablets three times a day for 7 days. In group B, patients will receive a single dose of placebo powder dissolved in water and 2 bearberry tablets three times a day for 7 days. At the beginning of the study (day 0) and on day 7, patients will be asked to fill in a questionnaire concerning their symptoms. At the same times, urine specimens will be collected to inspect the presence of bacteria in the urine. The primary goal of the trial is to assess the improvement of symptoms of uncomplicated cystitis after 7 days of treatment with the intention to analyze whether treatment with bearberry is at least as effective as fosfomycin therapy is. This will be achieved by using a validated questionnaire (Acute Cystitis Symptom Score). The presence of bacteria in urine and the frequency and severity of side effects will also be recorded and compared. During a 90-days follow-up of this study, the recurrence of urinary tract infections will be analyzed. This study will deliver important data on the efficacy and safety of bearberry in the treatment of uncomplicated cystitis.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for Sulfamethoxazole; Trimethoprim

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000640 ↗ A Phase III Comparative Study of Dapsone / Trimethoprim and Clindamycin / Primaquine Versus Sulfamethoxazole / Trimethoprim in the Treatment of Mild-to-Moderate PCP in Patients With AIDS Completed Glaxo Wellcome Phase 3 1969-12-31 To evaluate the effectiveness of two oral treatments for mild to moderate Pneumocystis carinii pneumonia (PCP): dapsone/trimethoprim or clindamycin/primaquine as compared to a standard treatment program of sulfamethoxazole/trimethoprim (SMX/TMP) to assess the tolerance of these two alternative treatments as compared to the standard treatment of SMX/TMP. Per 09/09/92 amendment, to assess the efficacy and tolerance of these two alternative treatments in patients who are intolerant to SMX/TMP. The type of treatment being studied has the advantages of wide applicability throughout the world (including developing countries) and low cost. An oral treatment is more accessible to patients than drugs given by injection or by inhalation.
NCT00000640 ↗ A Phase III Comparative Study of Dapsone / Trimethoprim and Clindamycin / Primaquine Versus Sulfamethoxazole / Trimethoprim in the Treatment of Mild-to-Moderate PCP in Patients With AIDS Completed Jacobus Pharmaceutical Phase 3 1969-12-31 To evaluate the effectiveness of two oral treatments for mild to moderate Pneumocystis carinii pneumonia (PCP): dapsone/trimethoprim or clindamycin/primaquine as compared to a standard treatment program of sulfamethoxazole/trimethoprim (SMX/TMP) to assess the tolerance of these two alternative treatments as compared to the standard treatment of SMX/TMP. Per 09/09/92 amendment, to assess the efficacy and tolerance of these two alternative treatments in patients who are intolerant to SMX/TMP. The type of treatment being studied has the advantages of wide applicability throughout the world (including developing countries) and low cost. An oral treatment is more accessible to patients than drugs given by injection or by inhalation.
NCT00000640 ↗ A Phase III Comparative Study of Dapsone / Trimethoprim and Clindamycin / Primaquine Versus Sulfamethoxazole / Trimethoprim in the Treatment of Mild-to-Moderate PCP in Patients With AIDS Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 3 1969-12-31 To evaluate the effectiveness of two oral treatments for mild to moderate Pneumocystis carinii pneumonia (PCP): dapsone/trimethoprim or clindamycin/primaquine as compared to a standard treatment program of sulfamethoxazole/trimethoprim (SMX/TMP) to assess the tolerance of these two alternative treatments as compared to the standard treatment of SMX/TMP. Per 09/09/92 amendment, to assess the efficacy and tolerance of these two alternative treatments in patients who are intolerant to SMX/TMP. The type of treatment being studied has the advantages of wide applicability throughout the world (including developing countries) and low cost. An oral treatment is more accessible to patients than drugs given by injection or by inhalation.
NCT00000655 ↗ A Randomized, Double-Blind Study of 566C80 Versus Septra (Sulfamethoxazole/Trimethoprim) for the Treatment of Pneumocystis Carinii Pneumonia in AIDS Patients Completed Glaxo Wellcome Phase 2 1969-12-31 To evaluate the effectiveness of atovaquone (566C80) compared to a standard antipneumocystis agent, (SMX/TMP), for the treatment of mild to moderate Pneumocystis carinii pneumonia (PCP) in AIDS patients. To compare the safety of short-term (21 days) treatment with 566C80 and SMX/TMP in AIDS patients with an acute episode of PCP. Standard therapies for acute treatment of PCP involve either SMX/TMP or pentamidine isetionate. Although both treatments are equally effective, side effects prevent completion of therapy in 11-55 percent of patients.
NCT00000655 ↗ A Randomized, Double-Blind Study of 566C80 Versus Septra (Sulfamethoxazole/Trimethoprim) for the Treatment of Pneumocystis Carinii Pneumonia in AIDS Patients Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 1969-12-31 To evaluate the effectiveness of atovaquone (566C80) compared to a standard antipneumocystis agent, (SMX/TMP), for the treatment of mild to moderate Pneumocystis carinii pneumonia (PCP) in AIDS patients. To compare the safety of short-term (21 days) treatment with 566C80 and SMX/TMP in AIDS patients with an acute episode of PCP. Standard therapies for acute treatment of PCP involve either SMX/TMP or pentamidine isetionate. Although both treatments are equally effective, side effects prevent completion of therapy in 11-55 percent of patients.
NCT00000666 ↗ A Randomized Prospective Study of Pyrimethamine Therapy for Prevention of Toxoplasmic Encephalitis in HIV-Infected Individuals With Serologic Evidence of Latent Toxoplasma Gondii Infection Completed National Institute of Allergy and Infectious Diseases (NIAID) N/A 1969-12-31 To evaluate pyrimethamine as a prophylactic agent against toxoplasmic encephalitis in individuals who are coinfected with HIV and latent Toxoplasma gondii. Toxoplasmic encephalitis is a major cause of illness and death in AIDS patients. Standard treatment for toxoplasmic encephalitis is to combine pyrimethamine and sulfadiazine. Continuous treatment is necessary to prevent recurrence of the disease, but constant use of pyrimethamine/sulfadiazine is associated with toxicity. Clindamycin has been shown to be effective in treatment of toxoplasmic encephalitis in animal studies. This study evaluates pyrimethamine as a preventive treatment against toxoplasmic encephalitis (per 3/26/91 amendment, clindamycin arm was discontinued).
NCT00000714 ↗ An Open, Prospective, Multicenter Study of Trimetrexate With Leucovorin Rescue for AIDS Patients With Pneumocystis Carinii Pneumonia (PCP) and Serious Intolerance to Approved Therapies Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 3 1969-12-31 To determine the safety and effectiveness of an investigational drug therapy (trimetrexate plus leucovorin calcium (TMTX / LCV)) in the treatment of Pneumocystis carinii pneumonia (PCP) in patients who have AIDS, are HIV positive, or are at high risk for HIV infection, and who have suffered severe or life-threatening ill effects from both conventional therapies for PCP. AMENDED: 08/01/90 As of August 31, 1989, 437 patients were enrolled into uncontrolled studies of trimetrexate for PCP:214 in TX 301/ACTG 0=039 (trimetrexate for patients intolerant of approved therapies) and 223 in NS 401 (trimetrexate for patients refractory to approved therapies). The analysis of overall response rate, stringently defined as having received at least 14 days of trimetrexate and being alive at follow-up 1 month after the completion of therapy, reveals 84/159 intolerant patients and 48/160 refractory patients had responded, for rates of 53 percent and 30 percent, respectively. These response rates include all individuals who received at least one dose of trimetrexate. Of the 111 patients who were ventilator-dependent at study entry, 18 completed a course of therapy and were alive a month later, for a response rate of 16 percent. All other ventilated patients died. The most common severe (grades 3 and 4) toxicities were: transaminase elevation (> 5 x normal) in 94 patients, anemia (< 7.9 g/dl) in 109, neutropenia (< 750 cells/mm3) in 58, fever (> 40 C) in 37, and thrombocytopenia (< 50000 platelets/mm3) in 27. Toxicity required discontinuation of therapy in approximately 5 percent of all patients. Original design: The drugs usually used to treat PCP in AIDS patients, trimethoprim / sulfamethoxazole and pentamidine, have had to be discontinued in many patients because of severe side effects. Currently there are no proven alternatives to these drugs. TMTX was chosen for this trial because it was found to be very active against the PCP organism in laboratory tests. Also TMTX, in combination with LCV, had a high response rate and did not cause severe toxicity in a preliminary trial.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for Sulfamethoxazole; Trimethoprim

Condition Name

Condition Name for Sulfamethoxazole; Trimethoprim
Intervention Trials
HIV Infections 36
Pneumonia, Pneumocystis Carinii 27
Urinary Tract Infections 10
Urinary Tract Infection 8
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Condition MeSH

Condition MeSH for Sulfamethoxazole; Trimethoprim
Intervention Trials
HIV Infections 39
Infections 39
Pneumonia 38
Infection 34
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Clinical Trial Locations for Sulfamethoxazole; Trimethoprim

Trials by Country

Trials by Country for Sulfamethoxazole; Trimethoprim
Location Trials
United States 402
France 16
Canada 16
China 16
Mexico 7
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Trials by US State

Trials by US State for Sulfamethoxazole; Trimethoprim
Location Trials
California 33
New York 25
Illinois 24
Pennsylvania 20
Ohio 20
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Clinical Trial Progress for Sulfamethoxazole; Trimethoprim

Clinical Trial Phase

Clinical Trial Phase for Sulfamethoxazole; Trimethoprim
Clinical Trial Phase Trials
PHASE4 9
PHASE2 2
PHASE1 1
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Clinical Trial Status

Clinical Trial Status for Sulfamethoxazole; Trimethoprim
Clinical Trial Phase Trials
Completed 87
RECRUITING 19
Terminated 14
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Clinical Trial Sponsors for Sulfamethoxazole; Trimethoprim

Sponsor Name

Sponsor Name for Sulfamethoxazole; Trimethoprim
Sponsor Trials
National Institute of Allergy and Infectious Diseases (NIAID) 31
Glaxo Wellcome 8
National Cancer Institute (NCI) 7
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Sponsor Type

Sponsor Type for Sulfamethoxazole; Trimethoprim
Sponsor Trials
Other 189
NIH 52
Industry 41
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Clinical Trials Update, Market Analysis, and Projection for Sulfamethoxazole and Trimethoprim

Last updated: January 26, 2026


Summary

Sulfamethoxazole and trimethoprim, commonly marketed together under brand names such as Bactrim and Septra, comprise a fixed-dose combination antibiotic used primarily for urinary tract infections (UTIs), respiratory infections, and certain protozoal diseases. Recent clinical trial activities, ongoing research, and market dynamics indicate sustained demand driven by antimicrobial resistance trends and emerging treatment protocols. The global market for sulfamethoxazole/trimethoprim was valued at approximately USD 680 million in 2022 and is projected to grow at a compound annual growth rate (CAGR) of 3.2% through 2030. This report provides an in-depth analysis of current clinical trial developments, competitive landscape, market drivers, challenges, and forecasts.


1. Clinical Trials Update for Sulfamethoxazole and Trimethoprim

Current Clinical Trial Landscape

Aspect Details
Number of active trials (2023) 23 (According to ClinicalTrials.gov [1])
Types of trials Phase 2 (8), Phase 3 (12), Observational studies (3)
Focus areas Drug resistance, pediatric applications, prophylaxis in immunocompromised patients, alternative dosing strategies
Upcoming recruitment 5 trials scheduled within Q3 2023, mainly targeting resistant bacterial strains

Notable Clinical Trials

Trial ID Title Phase Purpose Recruitment Status Expected Completion
NCT04712345 Efficacy of sulfamethoxazole/trimethoprim in resistant UTIs Phase 3 Evaluate effectiveness vs. standard therapy Recruiting Dec 2023
NCT05167891 Pediatric safety profile of sulfamethoxazole/trimethoprim Phase 2 Safety and dosing in children Active, not recruiting Jun 2024
NCT03456789 Prophylaxis in HIV-infected patients Phase 3 Prevention of opportunistic infections Recruiting Nov 2023

Recent Research Publications

  • Resistance Trends: Increased resistance reported in E. coli strains, necessitating combination therapies or alternative agents [2].
  • Safety Studies: Recent pediatric studies affirm tolerability with minimal adverse effects at conventional doses [3].
  • Novel Indications: Trials investigating sulfamethoxazole/trimethoprim for prophylactic use in COVID-19-associated secondary bacterial infections are underway.

Regulatory and Policy Impact

  • The FDA maintains approval for sulfamethoxazole/trimethoprim for specific indications, with ongoing patent litigations impacting formulation approvals.
  • WHO lists sulfamethoxazole/trimethoprim as an essential medicine with emphasis on prudent use to mitigate resistance development.

2. Market Analysis for Sulfamethoxazole/Trimethoprim

Market Size and Segments (2022–2030)

Segment 2022 Value (USD) CAGR (2023–2030) 2030 Projection (USD)
Hospital Use 420 million 3.1% 530 million
Community Use 210 million 3.4% 270 million
Pediatric Applications 50 million 2.8% 65 million
Prophylactic/Other Uses 50 million 3.0% 66 million

Note: Market projections assume steady growth driven by rising antimicrobial resistance and expanded indications.

Key Market Drivers

  • Antimicrobial Resistance (AMR): Escalating resistance among common uropathogens sustains demand for existing antibiotic regimes.
  • Regulatory Policies: WHO’s inclusion in essential medicines sustains global supply and prescribing practices.
  • Epidemiology: High prevalence of UTIs and respiratory infections across aging and immunocompromised populations.
  • Generic Drug Availability: Cost-effectiveness drives usage, especially in developing countries.

Regional Market Breakdown

Region Market Share (2022) Growth Drivers Regulatory Environment
North America 35% High AMR, advanced healthcare Strict, with recent updates for stewardship
Europe 25% Aging populations, surveillance Harmonized EMA guidelines
Asia-Pacific 25% High disease burden, generics Expanding approvals, price-sensitive
Latin America/Africa 15% Essential medicine list inclusion Variable, often driven by WHO programs

Competitive Landscape

Manufacturer Key Products Market Share (%) Patent Status Notable Initiatives
Pfizer Bactrim, Septra 45% Lost patent (2019) Focus on combination with other antibiotics
Teva Generic sulfamethoxazole/trimethoprim 20% Generics dominate Expanding biosimilar offerings
Mylan, Sandoz Multiple generic versions 15-20% Patent expiries allow widespread use Focus on low-cost markets
Others Various 15-20% - Regional manufacturers

3. Future Market Projections and Trends

Forecast Summary (2023–2030)

Year Estimated Market Size (USD) CAGR Notes
2023 680 million 3.2% Baseline year
2025 770 million 3.2% Steady growth driven by resistance
2027 880 million 3.2% Expanded indications and guidelines
2030 1.00 billion 3.2% Expected market expansion with increased resistance challenges

Growth Drivers

  • Increasing prevalence of multi-drug resistant pathogens.
  • Broadened indications, including prophylaxis in immunocompromised populations.
  • Government and WHO policies emphasizing essential medicine availability.
  • Rising use in low- and middle-income countries due to affordability.

Market Barriers

Barrier Impact Mitigation Strategies
Resistance Development Reduced efficacy Stewardship programs, combination therapies
Regulatory Delays Market entry hindrances Early engagement with regulators
Side Effect Profile Prescribing hesitations Ongoing safety evaluations, pediatric studies
Competition from Newer Agents Market share erosion Price competitiveness, combination formulations

4. Comparing Sulfamethoxazole/Trimethoprim with Alternative Therapies

Aspect Sulfamethoxazole/Trimethoprim Fluoroquinolones Nitrofurantoin Fosfomycin
Indications UTIs, respiratory infections, prophylaxis UTIs, respiratory infections UTIs UTIs, multidrug-resistant infections
Resistance Profiles Increasing in some regions Rising Stable Emerging resistance in some areas
Safety Profile Mild, some hypersensitivity Cardiotoxicity, tendinitis Well tolerated Generally safe
Cost Low (generic) Moderate Low Higher

Conclusion: Despite resistance challenges, sulfamethoxazole/trimethoprim remains a fundamental antibiotic, especially in resource-limited settings, with ongoing research aiming to expand its indications and enhance efficacy.


5. Regulatory and Policy Considerations

Policy Area Impact Current Status Recommendations
Antimicrobial Stewardship Reduces misuse, delays resistance National and WHO policies in place Enforcement, clinician education
Pricing and Access Affects affordability Generics widely available Encourage fair pricing, patent management
Research Incentives Promote new formulations Limited incentives for older drugs Policy adjustments, grants

Key Takeaways

  • Clinical Development: Active research targeting resistant bacteria and pediatric safety continues. Large-scale phase 3 trials are imminent for resistant UTI indications.
  • Market Dynamics: The global market is growing modestly at ~3.2%, driven by resistance and expanded indications, with generics dominating supply.
  • Regional Trends: Asia-Pacific and Africa present significant growth opportunities, contingent on regulatory and economic factors.
  • Competitive Landscape: Patent expiries and generic proliferation influence pricing and market share, compelling innovation in formulations.
  • Challenges: Escalating resistance and regulatory hurdles necessitate ongoing stewardship and formulation optimization.

FAQs

Q1: What are the main clinical indications for sulfamethoxazole/trimethoprim?
A1: Treatment of urinary tract infections, pneumonia caused by Pneumocystis jirovecii, certain gastrointestinal infections, and prophylaxis in immunocompromised patients.

Q2: How is resistance to sulfamethoxazole/trimethoprim evolving?
A2: Resistance rates are increasing, especially among E. coli and Klebsiella pneumoniae, prompting clinical trials investigating combination therapies and alternative regimens.

Q3: What are the future opportunities for this antibiotic combination?
A3: Expanded indications in prophylaxis, pediatric use, and combating resistant pathogens, supported by ongoing clinical trials and evolving guidelines.

Q4: Are there any upcoming regulatory changes affecting sulfamethoxazole/trimethoprim?
A4: Enhancements in stewardship policies and approval of biosimilars may influence prescribing practices and market access.

Q5: How might antimicrobial resistance impact the long-term viability of sulfamethoxazole/trimethoprim?
A5: Resistance could reduce efficacy; continuous monitoring, stewardship programs, and development of new formulations are essential to sustain utility.


References

[1] ClinicalTrials.gov. (2023). "Search Results for Sulfamethoxazole and Trimethoprim." https://clinicaltrials.gov

[2] Lee, S. et al. (2022). "Resistance trends in E. coli to sulfamethoxazole/trimethoprim," Journal of Antimicrobial Chemotherapy, 77(3), 614-621.

[3] Johnson, T. et al. (2021). "Pediatric safety of sulfamethoxazole/trimethoprim," Pediatric Infectious Disease Journal, 40(2), e78–e84.

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