Drug reference
Sulfadiazine is a short-acting sulphonamide with bacteriostatic activity against a broad spectrum of organisms. The importance of the sulfonamides has decreased as a result of increasing bacterial resistance and their replacement by antibacterials which are generally more active and less toxic.
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Prevention of rheumatic fever recurrence ▶BY MOUTH ▶Adult (body-weight up to 30 kg): 500 mg daily ▶Adult (body-weight 30 kg and above): 1 g daily
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Acute porphyrias p. 1120
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Asthma. avoid in blood disorders. elderly. G6PD deficiency (risk of haemolytic anaemia). maintain adequate fluid intake. predisposition to folate deficiency Myasthenia gravis (muscle weakness may be increased). systemic lupus erythematosus (may be exacerbated)
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SAFE PRACTICE Sulfadiazine has been confused with sulfasalazine; care must be taken to ensure the correct drug is prescribed and dispensed.
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→Appendix 1: sulfonamides
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▶Rare or very rare Haemolytic anaemia ▶Frequency not known Agranulocytosis. aplastic anaemia. appetite decreased. ataxia. back pain. blood disorders. cough. crystalluria. cyanosis. depression. diarrhoea. dizziness. drowsiness. dyspnoea. eosinophilia. erythema nodosum. fatigue. fever. haematuria. hallucination. headache. hepatic disorders. hypoglycaemia. hypoprothrombinaemia. hypothyroidism. idiopathic intracranial hypertension. insomnia. leucopenia. meningitis aseptic. myocarditis. nausea. nephritis tubulointerstitial. nephrotoxicity. nerve disorders. neurological effects. neutropenia. oral disorders. pancreatitis. photosensitivity reaction. pseudomembranous enterocolitis. psychosis. renal impairment. renal tubular necrosis. respiratory disorders. seizure. serum sickness-like reaction. severe cutaneous adverse reactions (SCARs). skin reactions. systemic lupus erythematosus (SLE). thrombocytopenia. tinnitus. vasculitis. vertigo. vomiting SIDE-EFFECTS, FURTHER INFORMATION Discontinue immediately if blood disorders (including leucopenia, thrombocytopenia, megaloblastic anaemia, eosinophilia) or rash (including Stevens-Johnson syndrome, toxic epidermal necrolysis) develop. ▶Common or very common Angioedema. diarrhoea. headache. Henoch-Schönlein purpura. hypersensitivity. nausea. pericarditis. photosensitivity reaction. skin reactions. systemic lupus erythematosus exacerbated. vomiting ▶Rare or very rare Appetite decreased. discolouration of thyroid gland. dysphagia. eosinophilia. fontanelle bulging (in infants). gastrointestinal disorders. haemolytic anaemia. hepatic disorders. idiopathic intracranial hypertension. increased risk of infection. neutropenia. oral disorders. pancreatitis. pseudomembranous enterocolitis. Stevens-Johnson syndrome. thrombocytopenia ▶Frequency not known Dizziness. tooth discolouration SIDE-EFFECTS, FURTHER INFORMATION Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment if raised intracranial pressure develops).
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Risk of neonatal haemolysis and methaemoglobinaemia in third trimester; fear of increased risk of kernicterus in neonates appears to be unfounded. Should not be given to pregnant women; effects on skeletal development have been documented in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child’s teeth, and maternal hepatotoxicity has been reported with large parenteral doses.
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Small risk of kernicterus in jaundiced infants and of haemolysis in G6PD-deficient infants. Should not be given to women who are breast-feeding (although absorption and therefore discoloration of teeth in the infant is probably usually prevented by chelation with calcium in milk).
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Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment or jaundice. In general, manufacturers advise caution. eiiii F above
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Use with caution in mild to moderate impairment; avoid in severe impairment; high risk of crystalluria.
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Monitor blood counts on prolonged treatment.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension Tablet CAUTIONARY AND ADVISORY LABELS 9, 27 ▶Sulfadiazine (Non-proprietary) Sulfadiazine 500 mg Sulfadiazine 500mg tablets | 56 tablet P £275.84 DT = £242.18 ANTIBACTERIALS › TETRACYCLINES AND RELATED DRUGS Tetracyclines Overview The tetracyclines are broad-spectrum antibiotics whose value has decreased owing to increasing bacterial resistance. They remain, however, the treatment of choice for infections caused by chlamydia (trachoma, psittacosis, salpingitis, urethritis, and lymphogranuloma venereum), rickettsia (including Q-fever), brucella (doxycycline p. 597 with either streptomycin p. 546 or rifampicin p. 615), and the spirochaete, Borrelia burgdorferi (See Lyme disease). They are also used in respiratory and genital mycoplasma infections, in acne, in destructive (refractory) periodontal disease, in exacerbations of chronic bronchitis (because of their activity against Haemophilus influenzae), and for leptospirosis in penicillin hypersensitivity (as an alternative to erythromycin p. 569). Tetracyclines have a role in the management of meticillin- resistant Staphylococcus aureus (MRSA) infection. Microbiologically, there is little to choose between the various tetracyclines, the only exception being minocycline p. 599 which has a broader spectrum; it is active against Neisseria meningitidis and has been used for meningococcal prophylaxis but is no longer recommended because of side- effects including dizziness and vertigo. Compared to other tetracyclines, minocycline is associated with a greater risk of lupus-erythematosus-like syndrome. Minocycline sometimes causes irreversible pigmentation. Tetracyclines f
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500 mg daily
First-line fragment. Read the complete Indications and Dose section above.
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1 g daily
First-line fragment. Read the complete Indications and Dose section above.
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