Dapsone Trimethoprim/Sulfamethoxazole

Dapsone and pyrimethamine should be used in patients that cannot tolerate sulfamethoxazole/trimethoprim with a CD4 count less than... 

Trimethoprim-sulfamethoxazole (TMP-SMX) (20 mg/kg/day of trimethoprim) is the treatment of choice for P. carinii pneumonia (PCP). Oral therapy with TMP-SMX is reserved for children with mild PCP who do not have malabsorption or diarrhea. Intravenous pentamidine (4 mg/kg/day, given once a day) can be given to children with PCP who are intolerant of TMP-SMX or who have not responded after 5 days of TMP-SMX therapy. Other treatment regimens that may be considered for patients who are intolerant of or fail TMP-SMX and pentimidine are (1) atovaquone (40 mg/kg/ day, in two divided doses) for mild/moderate PCP only (2) dapsone with trimethoprim (3) trimetrexate with leucovorin and (4) clindamycin and primaquine. These alternate treatments have limited experience in pediatric patients. 

Dapsone, combined with other antUeprosy agents like rifampin and clofazimine, is used in the treatment of both multibacillary and paucibacillary M. leprae infections. Dapsone is also used in the treatment and prevention of Pneumocystis carinii pneumonia in AIDS patients who are allergic to or intolerant of trimethoprim-sulfamethoxazole. 

The answers are 484-k, 483-j. (Hardman, pp 1061—1062, 1682-1683.) Sulfonamides can cause acute hemolytic anemia. In some patients it may be related to a sensitization phenomenon, and in other patients the hemolysis is due to a glucose-6-phosphate dehydrogenase deficiency. Sulfamethoxazole alone or in combination with trimethoprim is used to treat UTIs. The sulfonamide sulfasalazine is employed in the treatment of ulcerative colitis. Dapsone, a drug that is used in the treatment of leprosy, and primaquine, an antimalarial agent, can produce hemolysis, particularly in patients with a glucose-6-phosphate dehydrogenase deficiency. 

Pneumocystis jiroveci pneumonia (PCP) High-risk patients (eg, AIDS, leukemia, transplant) Trimethoprim-sulfamethoxazole, dapsone, or atovaquone Excellent... 

Toxoplasmosis Lymph nodes many organs and tissues Pyrimethamine-sulfadiazine [see antimalarial drugs] other antibacterials [clindamycin] Trimethoprim-sulfamethoxazole another agent [azithromycin, clarithromycin, atovaquone, or dapsone]... 

Holtzer CD, Flaherty JF Jr, Coleman RL. Cross-reactivity in HIV-infected patients switched from trimethoprim-sulfamethoxazole to dapsone. Pharmacotherapy 1998 18(4) 831-5. 

Sulfonamides, sulfadiazine, trimethoprim-sulfamethoxazole, pentamidine, pyrimethamine, dapsone, quinolones... 

Medina I, Mills J, Leoung G, Hopewell PC, Eee B, Modin G, et al. Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim-dapsone. The New England journal of medicine. 1990 Sep 20 323(12) 776-82. 

Lee BL, Medina 1, Benowitz NL, Jacob P, 3rd, Wofsy CB, Mills Jt. Dapsone, trimethoprim, and sulfamethoxazole plasma levels during treatment of Pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome (AIDS). Evidence of drug interactions. Annals of internal medicine. 1989 Apr 15 110(8) 606-n. 

Clinically important, potentially hazardous interactions with acitretin, aldesleukin, aminoglycosides, amiodarone, amoxicillin, ampicillin, aspirin, bacampicillin, bismuth, carbenicillin, chloroquine, cisplatin, cloxacillin, co-trimoxazole, dapsone, demeclocycline, dexamethasone, diclofenac, dicloxacillin, etodolac, etoricoxib, etretinate, fenoprofen, flurbiprofen, folic acid antagonists, haloperidol, hydrocortisone, ibuprofen, indomethacin, influenza vaccines, ketoprofen, ketorolac, lithium, magnesium trisalicylate, meclofenamate, mefenamic acid, methicillin, mezlocillin, minocycline, nabumetone, nafcillin, naproxen, NSAIDs, omeprazole, oxacillin, oxaprozin, oxytetracycline, paromomycin, penicillin G, penicillin V, penicillins, phenylbutazone, piperacillin, piroxicam, polypeptide antibiotics, prednisolone, prednisone, probenecid, procarbazine, rofecoxib, salicylates, salsalate, sapropterin, sulfadiazine, sulfamethoxazole, sulfapyridine, sulfasalazine, sulfisoxazole, sulindac, tazobactum, tenoxicam, tetracycline, ticarcillin, tolmetin, trimethoprim, vaccines... 

Since the first edition of this book was published there have been substantial advances in the treatment of human immunodeficiency virus (HIV) infection and the corollary acquired immunodeficiency syndrome (AIDS). Multiregimen antiretroviral therapy has allowed HIV/AIDS to be managed in a manner that was impossible in 1992. The development of successful treatments for HIV/AIDS and the effectiveness of antimicrobials, trimethoprim/sulfamethoxazole or dapsone, in the treatment of Pneumocystic carinii pneumonia (PCP) have reduced... 

Comparisons of the performance of two nebulizers in the delivery of pentamidine and their effectiveness in a community-based clinical trial have been reported [42]. The systems employed were the Respirgard II and the Fisoneb. Both systems provided comparable protection against PCP. The study supported the effectiveness of aerosolized pentamidine as a solid second-line prophylaxis for HIV-infected individuals who are tolerant to trimethoprim/sulfamethoxazole or dapsone. 

The incidence of Pneumocystis carinii pneumonia (PCP) within the first year after transplantation is reported to be 3% to 5%. " Low-dose trimethoprim-sulfamethoxazole (TMP-SMX 400 mg/ 80 mg three times weekly) is effective in the prevention of PCP infections. Alternative agents include aerosolized pentamidine (300 mg every month), dapsone, and atovaquone. The duration of PCP prophylaxis is unclear. The risk of infection caused by P. carinii is likely to decrease as immunosuppression is reduced therefore, prophylaxis in patients requiring treatment for acute rejection may be appropriate. 

Acetaminophen, arachidonic acid, benzo[a]pyrene, clozapine, cyclophosphamide, dapsone, dorzolamide, (i2)-fluoxetine, hexobarbital,(S)- and (f2)-ibuprofen, lauric acid, losartan, (S)- and (i )-naproxen, N-nitrosodimethylamine,ondansetron, phenylbutazone, piroxicam, 9-cis-retinoic acid, sulfadiazine, sulfamethoxazole, tetrahydrocannabinol, torasemide, trimethoprim,... 

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