Sulfonamides prophylaxis

Promoting an Optimal Response to Therapy The patient receiving a sulfonamide drug almost always lias an active infection. Some patients may be receiving one of Hiese drugs to prevent an infection (prophylaxis) or as part of Hie management of a disease such as ulcerative colitis. 

When the organism is susceptible and for prophylaxis when sulfonamide-sensitive group A str prevail. 

VI.a.2.4. Diaminopyrimidines. Pyrimethamine is a dihydrofolate reductase inhibitor, like the biguanides, and is structurally related to trimethoprim. It is seldom used alone. Pyrimethamine in fixed combinations with dapsone or sulfadoxine is used for treatment and prophylaxis of chloroquine-resistant falciparum malaria. The synergistic activities of pyrimethamine and sulfonamides are similar to those of trimethoprim/sulfonamide combinations. Resistant strains of Plasmodium falciparum have appeared world wide. Prophylaxis against falciparum... 

Pulmonary reactions have been described with most sulfonamides. Pyrimethamine -I- sulfadoxine, used in malaria prophylaxis and treatment, also rarely causes pulmonary reactions (17-19). The sulfapyridine moiety of sulfasalazine, used in inflammatory bowel disease, can produce adverse pulmonary reactions (20). 

No diagnostic tests are available to confirm sulfonamide hypersensitivity, and while avoidance of the drug is generally appropriate when a previous hypersensitivity reaction is suspected, desensitization protocols are available for use in HIV patients in whom Pneumocystis proved pneumonia prophylaxis or treatment is indicated (193). 

Although patients with HIV infection are more likely to develop generalized skin reactions to sulfonamides, they can be used for prophylaxis and therapy. 

AIDS." A primary infection that is treated with the combination is PCP. The sulfonamide-trimethoprim combination can be used fur treatment and prophylaxis. Additionally, cerebral toxoplasmosis con be treated in active infection or prophyluctically. Urinary tract infections and bum therapy" " " round out the list of therapeutic applications. The sulfonamides arc drugs of choice for a few other types of infections, but their u.sc is quite limited in modem antimicrobial chemotherapy." " "... 

The origins of antiviral therapies can be traced to the early 1950s, when sulfonamide antibiotics were tested for activity against poxviruses using mice infected with vaccinia (1). A decade of work at the Wellcome laboratories culminated in the development of methisazone, which was introduced in 1960 for the prophylaxis of smallpox (see Scheme 1). Notable success in the smallpox epidemic in Madras in 1963 demonstrated the value of this compound, but vaccines introduced soon after led to eradication of the disease and made the compound redundant. However, the principle that chemotherapy was effective for treating antiviral diseases had been demonstrated. 

Sulfacetamide is the IV-acetyl derivative of sulfanilamide. The sodium salt of sulfacetamide, because of its effectiveness and low toxicity, continues to be the most widely prescribed sulfonamide in the form of eye-drops and ointment for ophthalmic infections. It was introduced in Europe as "Albucid" in 1938 for various eye and other topical infections. Since its use in the treatment of corneal ulcers (1), sulfacetamide is still popular in ophthalmology. The sodium salt is highly soluble at the physiologic pH of 7.4, and is especially suited, as a 10-30% solution, for repeated topical application in the local management of ophthalmic infections (2-4). It is used mainly in the treatment of acute conjunctivitis and in the prophylaxis of ocular infections after injuries or burns (5). Several reviews on various aspects of sulfacetamide have been published (6-10). 

A 5-year-old Egyptian boy receives a sulfonamide antibiotic as prophylaxis for recurrent urinary tract infections. Although he was previously healthy and well-nourished, he becomes progressively ill and presents to your office with pallor and irritability. A blood count shows that he is severely anemic with jaundice due to hemolysis of red blood cells. Which of the following would be the simplest test for diagnosis ... 

Oral Therapy Sulfonamides Trimethoprim-sulfamethoxazole (TMP-SMX) These agents generally have been replaced by more agents due to resistance. This combination is highly effective against most aerobic enteric bacteria except Pseudomonas aeruginosa. High urinary tract tissue levels and urine levels are achieved, which may be important in complicated infection treatment. Also effective as prophylaxis for recurrent infections. 

Sulfacetamide, a sulfonamide antibiotic (instill 1 to 2 drops of 10% solution into lower conjunctival sac), is used in inclusion conjunctivitis, corneal ulcers, trachoma, and prophylaxis for ocular infection. 

Sulfadiazine, a sulfonamide antibiotic, is used in rheumatic fever prophylaxis, as an alternative to penicillin, as an adjunctive regimen in treatment of toxoplasmosis, and in uncomplicated attacks of malaria (see also Figure 90). 

Other Infections Actinomycosis, although most responsive to peniciUin G, may be successfully treated with a tetracychne. Minocychne is an alternative for the treatment of nocardiosis, but a sulfonamide should be used concurrently. Tetracychnes are useful in the acute treatment and for prophylaxis of leptospirosis. Borrelia spp., including B. recurrentis (relapsing fever) and B. burgdorferi (Lyme disease), respond to tetracychnes. The tetracychnes have been used to treat susceptible atypical mycobacteria. 

Thee antibiotics are effective in the treatment of infections caused by a wide range of gram-n ative and gram-positive microorganisms. In addition, the dru are used to treat acne vulgaris and sMn infections, in conjunction with sulfonamides to treat upper repiratoiy infections caused by Hemophilus influenzae, and e prophylaxis before dental or otlier procedure in patients alleigic to penicillin. 

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