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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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Pyrimethamine + sulfadoxine

Joseph Vinetz, M.D.; Paul A. Pham, Pharm.D.
10-21-2010

Zambia Specific Information

  • Available formulation in Zambia: sulfadoxine-pyrimethamine tablet: 500 mg + 25 mg.
  • No longer recommended for the treatment of malaria in South Africa.
  • Amodiaquine + sulfadoxine-pyrimethamine may be considered as an interim option in situations where Artemisinin-based combination therapy (ACTs) cannot be made available.

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • Prophylaxis and treatment of chloroquine-resistant malaria.
  • Malaria (acute) in combination with sulfadoxine and quinine in the treatment of chloroquine -resistant Plasmodium falciparum  malaria. Resistance prevalent worldwide (not recommended as a prophylactic agent for travelers to most areas).

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
FansidarPyrimethamine/SulfadoxineRochePO
tab
 Pyrimethamine 25 mg + sulfadoxine 500 mg
$3.92

*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

  • Treatment of uncomplicated malaria (in combination with quinine): 2-3 tablets PO as a single dose given on the last day of quinine (650 mg q8h x3-7 d).
  • Generally not used for prophylaxis due to the relatively frequent occurrence of side effects such as rash. Resistance has developed to these drugs, particularly in Africa and Southeast Asia.
  • Malaria prophylaxis: 1 tablet PO once a week 1 or 2 days before entering the endemic area and continued during the time of residence, and then for 4 to 6 weeks after leaving the area.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

No data.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

No data.

DOSING IN HEMODIALYSIS

No data: Sulfadoxine likely to be removed (may need to supplement).

DOSING IN PERITONEAL DIALYSIS

No data: 47% of pyrimethamine is excreted by PD (may need to supplement).

DOSING IN HEMOFILTRATION

No data.

ADVERSE DRUG REACTIONS

OCCASIONAL

  • Folic acid deficiency w/ megaloblastic anemia and pancytopenia, hemolytic anemia, leukopenia, thrombocytopenia
  • Allergic reaction
  • Transaminase elevations
  • GI intolerance: nausea, anorexia, vomiting
  • Headache
  • Dizziness
  • Insomnia
RARE

  • Severe cutaneous (e.g., Stevens Johnson, TEN)
  • Agranulocytosis, aplastic anemia, eosinophilia, hemolytic anemia (w/ G6PD deficiency), thrombocytepenic purpura.
  • Interstitial nephritis and crystalluria
  • Hypersensitivity pneumonititis
  • Polyarteritis nodosa

DRUG INTERACTIONS

  • Bone marrow suppressants (e.g., interferon, trimethoprim, zidovudine, and ganciclovir): may result in additive bone marrow suppression. Use with caution.
  • Aminobenzoic acid, benzocaine, procaine, tetracaine: potential sulfonamide antagonism. Avoid co-administration.
  • Aurothioglucose: may increase risk of blood dyscrasias.
  • Lorazepam: may increase the risk of hepatotoxicity.

SPECTRUM

Resistance common, can be detected by PCR methods. Less effective against P. vivax than P. falciparum.

Detailed Spectrum of Activity

PHARMACOLOGY

Pharmacology

COMMENTS

Fansidar is no longer the agent of choice for malaria prophylaxis due to the risk of severe cutaneous reactions (EM, TEN, and Stevens-Johnsons syndrome). However, for the treatment of uncomplicated malaria, Fansidar is recommended as a single dose (3tabs on the last day of quinine therapy) to prevent recrudescence 3-4 weeks later. Inexpensive and often used in Africa.

REFERENCES

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