Če trimetoprim kombiniramo s sulfametoksazolom, se pojavi sinergistični in baktericidni učinek, saj trimetoprim in sulfametoksazol zavirata zaporedne korake v sintezi tetrahidrofolne kisline, esencialnega presnovnega kofaktorja v bakterijski sintezi purinov in, posledično, DNK.
A synergistic and bactericidal effect occurs when trimethoprim is combined with sulfamethoxazole, because trimethoprim and sulfamethoxazole inhibit sequential steps in the synthesis of tetrahydrofolic acid, an essential metabolic cofactor in bacterial synthesis of purine and, subsequently, DNA.