The Basics

Type of Treatment: Rx Medication – Antibiotic (Oral) – Sulfonamide Family

How it Works: Co-Trimoxazole is an antibiotic. Antibiotics can improve acne symptoms by limiting the growth of bacteria that contribute to Acne Vulgaris.

When is this medication used? Co-trimoxazole is usually reserved for the treatment of mild to moderate acne symptoms (Acne Types: 2-4). Co-trimoxazole may also be used to treat non-typical acne (eg. Acne Fulminans).

Frequency of Co-Trimoxazole Resistant P. acnes Bacteria: Infrequent. (What does this mean?)

Official Name:  Co-Trimoxazole (Sulfamethoxazole and Trimethoprim).
Popular Brand Names: Bactrim, Cotrim, Co-Trimox, Septra, Septrin and Sulfatrim.
Related Medications: Sulfadiazine, Dapsone, Sulfacetamide and Sulfamylon.

Important Note: The information provided on this site is intended for informational purposes only and is not intended to diagnose or treat any diseases. The Science of Acne strongly encourages you to consult a qualified medical professional before making any treatment decisions. For the complete disclaimer, click here.

Co-Trimoxazole and Acne

Research into the antibiotic susceptibility of P. acnes bacteria indicates that these acne-causing bacteria are usually susceptible to treatment with co-trimoxazole.  While co-trimoxazole does not appear to be quite as toxic to P. acnes as pencillin familyantibiotics (in laboratory testing), there have been numerous reports of excellent improvement in acne patients being treated with co-trimoxazole.

Importantly, co-trimoxazole may be a good treatment for those people whose acne does not improve with tetracycline treatment.  A European study found that 79% of people who suffered from tetracycline-resistant acne experienced significant improvement in their acne symptoms after switching to co-trimoxazole (400 mg sulfamethoxazole/80 mg trimethoprim twice daily).

Co-trimoxazole also has a unique ability to accumulate within white blood cells.  For people who suffer from chronic inflammatory acne, this can be a very important quality.  In some people who suffer from chronic infection, the fundamental problem is that their white blood cells are not as efficient at engulfing and destroying infectious agents, like P. acnes bacteria.  Because co-trimoxazole can penetrate into white blood cells, it can help white blood cells destroy bacteria.  This may help improve some acne symptoms, particularly in cases of inflammatory acne.

Research has also indicated that co-trimoxazole treatment may alter the composition of sebum, decreasing the proportion of free fatty acids and increasing the proportion of triglycerides.  How and why this change occurs is unknown, but elevated levels of free fatty acids are associated with increased severity of acne-related inflammation.  The bottom line appears to be that co-trimoxazole treatment can be a very effective acne treatment, particularly in cases of inflammatory acne that fails to respond to other antibiotics.

Patient Reviews of Co-Trimoxazole

Co-Trimoxazole (Bactrim, Septra)is generally well reviewed by acne patients. In many cases, this medication is highly effective, particularly for patients with moderate to severe inflammatory acne. However, this medication has a higher risk for severe allergic reactions than many other types of antibiotics.

The EFFECTIVENESS ranking is based on patient reports of how effective this medication was at improving their acne symptoms.

This ranking is scored on a scale of 1 (NOT EFFECTIVE) to 5 (VERY EFFECTIVE).

If you have used Co-trimoxazole as a treatment for acne, please share your experience here.

Additional Sources of patient reviews for this medication: Co-Trimoxazole Reviews @ Acne.org, Co-Trimoxazole Reviews @ WebMD, Co-Trimoxazole Reviews @ Drugs.com, Co-Trimoxazole Reviews @ DailyStrength.org, Co-Trimoxazole Reviews @ EverydayHealth.com, Co-Trimoxazole Reviews @ RXList.com, Co-Trimoxazole Reviews @ DrugLib.com.

Cost and Availability of Co-Trimoxazole

If possible, co-trimoxazole should be obtained through consultation of a qualified medical professional. Some physicians and general practitioners may be uncomfortable with the use of co-trimoxazole for the treatment of acne vulgaris.  The use of co-timoxazole to treat acne is considered an “off-label” use in many countries.  Co-Trimoxazole is widely available in brand name and generic formulations. In brand name formulations this medication tends to be moderately expensive, and in generic formulation it tends to be inexpensive.

Co-Trimoxazole Side Effects

The SIDE EFFECTS ranking is scored on a scale of 1 (NO SIDE EFFECTS) to 5 (SEVERE SIDE EFFECTS).

If you have used Co-trimoxazole as a treatment for acne, please share your experience here.

Co-trimoxazole is a mixture of trimethoprim and sulfamethoxazole, usually in a ratio of 1:5 (trimethoprim:sulfamethoxazole).  The most common adverse effects of co-trimoxazole are mild headaches, dizziness, rashes, hives and fever. Like many other antibiotics, allergic reactions are often characterized by the formation of a rash or hives.  Rashes are usually self-limiting, but if a rash does develop, the general recommendation is to stop treatment and consult your medical care provider.  Approximately 10-15% of patients report some sort of adverse reaction to co-trimoxazole treatment.

A more serious potential complication associated with co-trimoxazole treatment is Stevens-Johnson syndrome (Erythema multiforme). This is a rare but serious complication that can cause significant damage to blood vessels and skin.

The trimethoprim in co-trimoxazole may also cause folate deficiency. Problems with folate metabolism is more likely in patients with pre-existing folate deficiency. Folic acid supplementation can generally correct deficiency related complications.   Co-trimoxazole use is also usually avoided in pregnant women and young children.

For in-depth information about potential side effects of co-trimoxazole treatment, refer to the physician’s insert or consult a medical professional.  For more information about contraindications in general, refer to Avoiding Negative Drug Interactions.

Co-Trimoxazole Background

Co-Trimoxazole  is a combination of two syngeristic antibiotics – sulfamethoxazole and trimethoprim.  The combination of these two antibiotics kills bacteria by blocking their ability to synthesize folic acid.  Folic acid is an essential B-complex vitamin that most organisms need in order to survive.

Co-Trimoxazole is not as commonly used in acne treatment as the tetracycline antibiotics (eg. doxycycline and minocycline).  However, in many cases co-trimoxazole is more effective, particulary in cases of moderate to severe inflammatory acne.  Increasing levels of tetracycline-resistant P. acnes bacteria have led to renewed interest in the use of alternative antibiotics for the treatment of acne symptoms.  Co-timoxazole has unique qualities that may be uniquely helpful in the treatment of acne vulgaris.  Unlike most antibiotics, co-trimoxazole can accumulate inside of white blood cells.  This feature may be helpful in treating certain kinds of chronic infection and inflammation (including some types of acne).

Co-Trimoxazole does have an increased risk of certain side effects when compared to other common antibiotics, a fact which makes some physicians and dermatologists uncomfortable prescribing this medication.  Before the development of highly effective retroviral therapy for the treatment of HIV/AIDS, co-trimoxazole was commonly used as a prophylactic treatment for HIV/AIDS patients to prevent bacterial infections.

Additional Names for this Medication: Actrim, Anitrim, Apo-Sulfatrim, Assepium, Bacin, Bactekod, Bacticel, Bactoprim, Bactramin, Bactricid, Bactrimel, Balkatrin, Berlocid, Bethaprim, Bioprim, Biotrim, Biseptol, Biseptrin, Bismoral, Casicot, Chemitrim, Ciplin, Cotribene, Co-Trimoxazol, Cotrimox, Cotrimoxazol, Cotrimstada, Cozole, Daiphen, Deprim, Dientrin, Diseptyl, Dotrim, Drylin, Ectaprim, Escoprim, Eusaprim, Groseptol, Infectrin, Irgagen, Kepinol, Lagatrim, Letus, Lupectrin, Metoprim, Metoxiprim, Momentol, Netocur, Novidrine, Novo-Trimel, Omsat, Oribact, Oriprim, Primazol, Primotren, Purbac, Qiftrim, Resprim, Sepmax, Septran, Septran DS, Sigaprim, Sinersul, Soltrim, Sulfaméthoxazole and Triméthoprime, Sulfamethoxazolum and Trimethoprimum, Sulfametoxazol and Trimetoprima, Sulphamethoxazole and Trimethoprim, Sultrex, Sumetrolim, TMP/SMZ, TMP-sulfa, TMS, Trim/Sul, Trimidar-M, Trimoks, Trisul, Uroplus Vanadyl, Yen Kuang and Zoltrim.

Related Topics from The Science of Acne

Co-Trimoxazole (Bactrim, Septra) Comprehensive Patient Reviews
Overview: Avoiding Negative Drug Interactions
A Guide to Buying Prescription Medications on the Internet
Overview: Prescription Medications Used in Acne Treatment
In Depth: Antibiotic Susceptibility of Propionibacterium acnes

References and Sources

Books

PDR Staff Writers. 2011. 2011 Physicians’ Desk Reference
Gallagher. 2011. Antibiotics Simplified, Second Edition
Habif. 2009. Clinical Dermatology
Goodheart. 2006. Acne For Dummies
Bartlett. 2012. Johns Hopkins Antibiotics Guide 2012

Online Resources

Co-Trimoxazole @ PubMed Health – The National Institute of Health (US) offers basic comprehensive information about most common medications.
Co-Trimoxazole @ Wikipedia – Wikipedia is an excellent resource for learning about how medications work.
Co-Trimoxazole Physician’s Insert – The physician’s insert for a medication contains nearly all of the relevant information, including indications, dosage information and background data.

Scientific Research Articles

Hersle, et al. 1972. Trimethoprim-Sulphamethoxazole in Acne vulgaris A Double-Blind Study.
Nordin, et al. 1978. A clinical and bacteriological evaluation of the effect of sulphamethoxazole-trimethoprim in acne vulgaris, resistant to prior therapy with tetracyclines.
Gibson, et al. 2006. Oral trimethoprim versus oxytetracycline in the treatment of inflammatory acne vulgaris.
Cotterill, et al. 2006. The Effect of Trimethoprim-Sulphamethoxazole on Sebum Excretion Rate and Biochemistry in Acne Vulgaris.
Oprica, et al. 2004. Antibiotic-resistant Propionibacterium acnes on the skin of patients with moderate to severe acne in Stockholm.
Reeves, et al. 1978. Use of antibiotics: Sulphonamides, Co-Trimoxazole, and Tetracyclines.
Zaenglein, et al. 2006. Expert Committee Recommendations for Acne Management.
Federman, et al. 2000. Acne Vulgaris: Pathogenesis and Therapeutic Approach.
Haider, et al. 2004. Treatment of Acne Vulgaris.