Sulfonamides kernicterus with

Contraindications Sulfas should be avoided in newborns and infants less than 2 months old as well as pregnant women at term, due to the danger of kernicterus. Because sulfonamides condense with formaldehyde, they should not be given to patients receiving methenamine (see p. 327) for urinary tract infections. 

Host factors can help to ensure selection of the most appropriate antimicrobial agent. Age is an important factor in antimicrobial selection. With regard to dose and interval, renal and hepatic function varies with age. Populations with diminished renal function include neonates and the elderly. Hepatic function in the neonate is not fully developed, and drugs that are metabolized or eliminated by this route may produce adverse effects. For example, sulfonamides and ceftriaxone may compete with bilirubin for binding sites and may result in hyperbilirubinemia and kernicterus. Gastric acidity also depends on... 

Lactation Sulfonamides are excreted in breast milk. In newborns, they compete with bilirubin for binding sites on the plasma proteins and may cause kernicterus. Children The safety and efficacy of sulfasalazine in pediatric patients younger than 2 years of age with ulcerative colitis have not been established. 

Lactation TMP-SMZ is not recommended in the nursing period because sulfonamides are excreted in breast milk and may cause kernicterus. Premature infants and infants with hyperbilirubinemia or G-6-PD deficiency are also at risk for adverse effects. 

Sulfasalazine is contraindicated in individuals with hypersensitivity to salicylates, sulfonamides, sulfonylureas, and certain diuretics (furosemide, thiazides, and carbonic anhydrase inhibitors). Because it can cause kernicterus, sulfasalazine is contraindicated in infants and children under 2 years of age. Sulfasalazine passes into breast milk and is therefore contraindicated for nursing mothers. Similarly, pregnant women near term should not use this drug, although it appears to be the safest of the DMARDs during early pregnancy. 

Sulfonamides can cause hemolytic or aplastic anemia, granulocytopenia, thrombocytopenia, or leukemoid reactions. Sulfonamides may provoke hemolytic reactions in patients with glucose-6-phosphate dehydrogenase deficiency. Sulfonamides taken near the end of pregnancy increase the risk of kernicterus in newborns. 

Sulfonamides are contraindicated in patients with known hypersensitivity or intolerance to any member of this drug femily. Sulfonamides are also contraindicated in pregnancy at term, for nursing mothers, and for infants less than 2 months old becanse they can promote kernicterus in the newborn by displacing bilirubin from plasma proteins. The sulfonamides, pyrimethamine, and trimethoprim are contraindicated in patients with documented blood dyscrasias. 

Sulfonamides should not be given to pregnant women in the third trimester of pregnancy. They can displace bilirubin from plasma albumin and cause kernicterus (bilirubin encephalopathy) (205-208). For the same reason, the administration of sulfonamides to lactating women or premature infants should be avoided. Successful treatment of neonatal hyperbilirubinemia with higher bilirubin concentrations has been established using exchange transfusion and phototherapy. 

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