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Last Updated: January 17, 2025

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).
>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 9
Urinary Tract Infection 8
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Condition MeSH

Condition MeSH for Sulfamethoxazole; Trimethoprim
Intervention Trials
HIV Infections 39
Infections 38
Pneumonia 36
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 396
France 16
China 16
Canada 15
Mexico 7
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Trials by US State

Trials by US State for Sulfamethoxazole; Trimethoprim
Location Trials
California 32
New York 25
Illinois 24
Pennsylvania 20
Ohio 19
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Clinical Trial Progress for Sulfamethoxazole; Trimethoprim

Clinical Trial Phase

Clinical Trial Phase for Sulfamethoxazole; Trimethoprim
Clinical Trial Phase Trials
Phase 4 28
Phase 3 38
Phase 2/Phase 3 6
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Clinical Trial Status

Clinical Trial Status for Sulfamethoxazole; Trimethoprim
Clinical Trial Phase Trials
Completed 87
Recruiting 15
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 178
NIH 52
Industry 40
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Sulfamethoxazole and Trimethoprim: Clinical Trials, Market Analysis, and Projections

Introduction

Sulfamethoxazole and trimethoprim (TMP/SMX) is a widely used antibiotic combination, particularly for the prophylaxis and treatment of various bacterial infections, including Pneumocystis pneumonia (PCP) in immunocompromised patients. This article delves into recent clinical trials, market analysis, and future projections for this drug.

Clinical Trials Update

Efficacy and Safety of Intermittent vs. Daily Regimens

A recent systematic review and meta-analysis compared the efficacy and safety of intermittent versus daily TMP/SMX regimens for PCP prophylaxis. The study included four randomized controlled trials (RCTs) involving 2808 patients. It found that the incidence of PCP did not differ significantly between the intermittent and daily regimen groups. However, the intermittent regimen group experienced significantly fewer adverse events requiring temporary or permanent TMP/SMX discontinuation, with a risk ratio of 0.51 (95% CI, 0.42–0.61)[1].

Adverse Events and Tolerability

The study highlighted that intermittent TMP/SMX regimens may be more tolerable than daily regimens, with similar efficacy. This is crucial for patient adherence and overall treatment success. However, further RCTs are needed to solidify these findings and integrate them into current clinical practice.

Specific Adverse Events

TMP/SMX is associated with several adverse events, including hyperkalemia, particularly in elderly patients treated with spironolactone. A population-based study found that trimethoprim-sulfamethoxazole was strongly associated with hospital admissions for hyperkalemia, with an adjusted odds ratio of 12.4 (95% CI, 7.1 to 21.6) compared to amoxicillin[3].

Market Analysis

Market Size and Growth

The global sulfamethoxazole and trimethoprim market has experienced significant growth and is projected to continue this trend. As of 2024, the market size is valued at approximately USD 1.56 billion and is expected to rise to USD 2.1 billion by 2032, with a Compound Annual Growth Rate (CAGR) of 3.76% during the forecast period[5].

Market Segmentation

The market is segmented based on type (80mg Trimethoprim and 400mg Sulfamethoxazole, 160mg Trimethoprim and 800mg Sulfamethoxazole) and application (Adult Use, Pediatric Use). Geographically, the market is analyzed across regions such as North America, Europe, Asia-Pacific, South America, and the Middle East and Africa[2][5].

Key Players

The market is dominated by several key players, including Intas Pharmaceuticals Ltd., Macleods Pharmaceuticals Ltd., Glenmark Pharmaceuticals Ltd., Cipla Ltd., and Cadila Healthcare Ltd. These companies play a significant role in driving market growth through new product developments and technological advancements[5].

Market Dynamics

Drivers and Restraints

The growth of the sulfamethoxazole and trimethoprim market is driven by increasing bacterial infections, the need for effective prophylaxis in immunocompromised patients, and advancements in pharmaceutical technology. However, the market is also restrained by the potential for adverse events, drug interactions (such as with spironolactone), and the emergence of antibiotic-resistant bacteria[5].

Regional Analysis

The Asia-Pacific region is expected to be a significant growth driver due to the large patient population and increasing healthcare expenditure. North America and Europe also remain key markets due to their well-established healthcare systems and high demand for effective antibiotics[5].

Future Projections

Market Growth

The sulfamethoxazole and trimethoprim market is anticipated to register robust growth from 2024 to 2032, driven by the increasing demand for antibiotics and the expanding patient base. The market's growth will also be influenced by the development of new formulations and dosing regimens that enhance patient safety and adherence[5].

Technological Trends

Advancements in pharmaceutical technology, such as the development of more tolerable dosing regimens and formulations with reduced side effects, will play a crucial role in the market's future growth. Additionally, research into new applications and indications for TMP/SMX could further expand its market share[5].

Clinical Implications

Hyperkalemia Risk

Clinicians should be aware of the significant risk of hyperkalemia associated with TMP/SMX, especially in patients receiving spironolactone. Strategies to minimize this risk, such as monitoring potassium levels and avoiding TMP/SMX when clinically appropriate, are essential[3].

Adverse Event Management

The use of a mnemonic like “NOT RISKY?” can help clinicians recall the various toxicities associated with TMP/SMX, including hematologic, renal, and metabolic adverse events. Early recognition and management of these adverse events can improve patient outcomes[4].

Key Takeaways

  • Intermittent vs. Daily Regimens: Intermittent TMP/SMX regimens may offer similar efficacy with fewer adverse events compared to daily regimens.
  • Market Growth: The global sulfamethoxazole and trimethoprim market is projected to grow significantly from 2024 to 2032.
  • Adverse Events: TMP/SMX is associated with serious adverse events, including hyperkalemia, especially in elderly patients on spironolactone.
  • Regional Dynamics: The Asia-Pacific region is expected to drive market growth due to its large patient population and increasing healthcare expenditure.
  • Technological Advancements: New formulations and dosing regimens will be crucial for future market growth and patient safety.

FAQs

What are the primary outcomes of the recent clinical trials comparing intermittent and daily TMP/SMX regimens?

The primary outcomes include PCP incidence, PCP-related mortality, and adverse events requiring temporary or permanent TMP/SMX discontinuation. The trials found no significant difference in PCP incidence but a significant reduction in adverse events with intermittent regimens[1].

What is the projected market size of the sulfamethoxazole and trimethoprim market by 2032?

The market is expected to rise to USD 2.1 billion by 2032, with a CAGR of 3.76% during the forecast period[5].

What are the key adverse events associated with TMP/SMX?

Key adverse events include hyperkalemia, hematologic toxicities such as immune thrombocytopenia and leukopenia, and metabolic adverse events like hypoglycemia in patients on sulfonylureas[3][4].

Which regions are expected to drive the growth of the sulfamethoxazole and trimethoprim market?

The Asia-Pacific region, along with North America and Europe, is expected to be a significant driver of market growth due to large patient populations and increasing healthcare expenditure[5].

What are the implications of the drug interaction between TMP/SMX and spironolactone?

The interaction significantly increases the risk of hyperkalemia, and clinicians should avoid prescribing TMP/SMX to patients on spironolactone when clinically possible to minimize this risk[3].

Sources

  1. Intermittent Versus Daily Trimethoprim/Sulfamethoxazole Regimens for Pneumocystis Pneumonia Prophylaxis in Immunocompromised Individuals: A Systematic Review and Meta-Analysis. Open Forum Infectious Diseases, 2024.
  2. Sulfamethoxazole and Trimethoprim Market Size, Scope And Forecast 2023-2031. Market Research Intellect, 2024.
  3. Trimethoprim-sulfamethoxazole induced hyperkalaemia in elderly patients receiving spironolactone: a population based study. BMJ, 2011.
  4. Considerations when prescribing trimethoprim–sulfamethoxazole. Canadian Medical Association Journal, 2011.
  5. Sulfamethoxazole Trimethoprim Market Overall Study Report 2024-2032. OpenPR, 2024.

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