Category:

• Antibiotic

Description:

• Sulfonamide antibiotic

Indications:

• Chancroid

• Inclusion conjunctivitis

• Malaria (adjunctive therapy)

• Meningitis (meninogococcal)

• Nocardiosis

• Acute otitis media (caused by H. influenzae when used with penicillins)

• Toxoplasmosis

• Trachoma

• Urinary tract infections (pyelonephritis, cystitis)

Contraindications:

• Hypersensitivity to sulfa-related medications (sulfonylureas, thiazide and loop diuretics, carbonic anhydrase inhibitors, sunscreens with PABA, local anesthetics)

• Pregnancy at term

• Lactation

• Infants less than 2 months old (except congenital toxoplasmosis as adjunct with pyrimethamine)

Precautions:

• Pregnancy category C

• Sulfonamides have been associated with severe hypersensitivity reactions and death.

• Serious blood disorders (agranulocytosis, hepatocellular necrosis, aplastic anemia) have been associated with sulfonamides.  Perform complete blood counts.  Symptoms of sore throat, fever, pallor, purpura or jaundice may be early signs of serious blood disorders.

• Use with caution in patients with severe asthma or allergies.

• Hemolytic anemia may occur in patients with G-6-PD deficiency.

• Photosensitization may occur, caution patients to use protective measures against ultraviolet or sunlight until tolerance is determined.

• Sulfonamides increase the effect of oral anticoagulants (warfarin).

• Take with a full glass of water and increase fluid intake to 2-3 liters per day.

• Complete full course of therapy.

Adverse Reactions (Side Effects):

• Headache, peripheral neuropathy, depression

• Tinnitis, vertigo

• Nausea, emesis, abdominal pain, anorexia, diarrhea

• Hepatitis, pancreatitis, stomatitis

• Urticaria, Stevens-Johnson type erythema multiforme

• Crystalluria, elevated creatinine

• Drug fever, chills

• Photosensitivity

Dosage:

Administered orally (tablets)

• Adults:

• Mild/moderate infections: 

  • loading dose: 2 grams

  • maintenance dose: 1 gram q12h

• Severe infections: 

  • loading dose: 2 grams, 

  • maintenance dose: 1 gram q8h

• Children (>2 months):

  • Initial dose: 50-60mg/kg

  • Maintenance dose: 25-30mg/kg q12h (maximum of 75mg/kg per day)

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
20372-5300

Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001