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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Sulfadiazine

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
12-07-2010

Zambia Specific Information

  • Available formulation in Zambia: 500 mg tablet 
  • First-line treatment of CNS toxoplasmosis: pyrimethamine + sulfadiazine (plus folinic acid).
  • Maintain adequate hydration to prevent crystalluria
Zambia Information Author: Paul A. Pham, Pharm.D.

INDICATIONS

FDA

  • CNS and ocular toxoplasmosis (in combination with pyrimethamine); nocardiosis.
  • Malaria due to chloroquine-resistant P. falciparum malaria (in combination with quinine and pyrimethamine).
  • UTI (also FDA indicated for pyelonephritis, but generally reserved for uncomplicated UTI). Sulfamethoxazole preferred.
  • FDA indicated, but not generally recommended: Chancroid; trachoma; inclusion conjunctivitis.
  • FDA indicated, but not generally recommended: Prophylaxis of meningococcal meningitis when sulfonamide-sensitive group A strains known to prevail; meningococcal meningitis; acute otitis media due to H. influenzae (in combination with PCN); prophylaxis against recurrences of rheumatic fever (alternative to penicillin); H. influenzae meningitis (in combination with streptomycin)

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
SulfadiazineSulfadiazine Sandozoral
tab
500 mg
$2.50per 500 mg tab

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

  • CNS and ocular toxoplasmosis (induction phase): sulfadiazine 1-1.5gm PO q6h (+ leucovorin 10-20 mg PO once-daily and pyrimethamine 100-200 mg PO loading dose, then 50-100 mg PO once-daily x 6 wks)
  • CNS and ocular toxoplasmosis (maintenance phase): sulfadiazine 50 0mg PO q6h (+ leucovorin 10-20 mg PO once-daily and pyrimethamine 25-50 mg PO once-daily) until immune reconstitution (CD4 >200 x 6 mos and on stable ART)
  • Treatment of norcardiosis: 1.5 gm PO q6h x >6 mos; SMX/TMP preferred (CID 1996;22:891-903). Target serum level: 100-150 g/mL (2 hrs after dose)
  • Ocular toxoplasmosis: sulfadiazine 1 gm q6h (+ leucovorin 15 mg PO once-daily and pyrimethamine 100 mg PO x1, then 50 mg PO once-daily x 4 wks). Additional treatment if pt has dense vitreous floaters, active retinal inflammation, or both (Am J Ophthalmol 2002;134:34-40).

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

0.5-1.5 gm q6h

DOSING FOR GLOMERULAR FILTRATION OF 10-50

0.5-1.5gm q8-12h (approx. half dose)

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

0.5-1.5 gm q12h-24h (approx. 1/3 dose); HD: no data, dose post-HD

DOSING IN HEMODIALYSIS

No data, consider 0.5-1.5 gm q12-24h

DOSING IN PERITONEAL DIALYSIS

No data, consider 0.5-1.5 gm q12-24h

DOSING IN HEMOFILTRATION

No data, consider 0.5-1.5 gm q8h-12h

ADVERSE DRUG REACTIONS

COMMON

  • GI intolerance with nausea and vomiting
  • Rash and pruritus
OCCASIONAL

  • Bone marrow suppression (anemia, thrombocytopenia, leukopenia)
  • Serum sickness and drug fever
  • Crystalluria with azotemia, urolithiasis,oliguria. May be prevented by adequate hydration (daily urinary output >1500 ml) and alkalinizing urine to pH >7.15.
  • Photosensitivity
  • Hepatitis
RARE

  • TEN and Stevens-Johnson syndrome
  • Encephalopathy
  • Pancreatitis

DRUG INTERACTIONS

  • Warfarin: may increase INR. Monitor closely.
  • Sulfonylurea: may increase hypoglycemia. Monitor closely with coadministration.
  • Cyclosporine: may decrease cyclosporine serum levels. Monitor levels closely; may require dose increase.
  • Phenytoin: may increase phenytoin serum levels. Monitor free phenytoin levels with co-administration.
  • Porfimer: may increase the risk of photosensitivity reaction. Avoid co-administration.
  • Para-aminobenzoic acid (PABA) and derivatives (such as benzocaine, procaine, tetracaine): theoretical antagonism. Avoid co-administration.

SPECTRUM

Toxoplasma gondii; P. falciparum

Detailed Spectrum of Activity

PHARMACOLOGY

Pharmacology

COMMENTS

Agent of choice for toxoplasmosis (with pyrimethamine) due to superior CNS penetration and extensive clinical data. Higher incidence of crystaluria compared to other sulfonamides. This regimen also provides PCP prophylaxis.

REFERENCES

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