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Trimethoprim is a synthetic antibacterial agent primarily used to treat urinary tract infections and other bacterial infections such as otitis media and traveler's diarrhea. It is also used in combination with other drugs (notably sulfamethoxazole) for the treatment of Pneumocystis jirovecii pneumonia in immunocompromised patients. Trimethoprim acts by selectively inhibiting bacterial dihydrofolate reductase, an enzyme essential for folic acid synthesis in bacteria. This inhibition blocks the reduction of dihydrofolic acid to tetrahydrofolic acid, thereby interfering with thymidine synthesis and ultimately inhibiting bacterial DNA replication and cell division. Its selectivity for the bacterial enzyme over the human counterpart makes it effective as an antibiotic[1][2][5].
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