Sulphadiazine

Indications
Oral
Susceptible infections
Adult: Initially, 2-4 g/day. May increase up to 6 g/day, given in divided doses.
Child: Start with 75 mg/kg, subsequently, 150 mg/kg in divided doses. Max: 6 g/day.
Renal impairment: Dosage reduction may be necessary.
Oral
Prophylaxis of rheumatic fever
Adult: >30 kg: 1 g once daily; <30 kg: 500 mg once daily.
Child: <30 kg: 0.5 g every 24 hr; >30 kg: 1 g/day.
Renal impairment: Dosage reduction may be necessary.
Oral
Nocardiosis
Adult: 4-8 g daily for at least 6 wk. May continue for many mth to prevent relapse of infection.
Renal impairment: Dosage reduction may be necessary.
Oral
Toxoplasmosis
Adult: Including immunocompromised patients: 4-6 g/day in 4 divided doses for at least 6 wk. Subsequently, 2-4 g/day, to be continued indefinitely.
Child: For congenital toxoplasmosis: <2 mth: 50 mg/kg bid for 12 mth.
Renal impairment: Dosage reduction may be necessary.
Oral
Prophylaxis of toxoplasmosis in patients with HIV infection
Adult: 0.5-1 g every 6 hr, to be taken with oral pyrimethamine (25-50 mg daily) and oral leucovorin (10-25 mg/day).
Child: 85-120 mg/kg/day, given in 2-4 divided doses with oral pyrimethamine (1 mg/kg/day; max: 25 mg/day) and oral leucovorin (5 mg once every 3 days).
Renal impairment: Dosage reduction may be necessary.
Contraindications
Hypersensitivity; severe renal/hepatic impairment, blood dyscrasias, porphyrias, pregnancy (at term), lactation.
Warnings / Precautions
Elderly, maintain adequate fluid intake to reduce risk of crystalluria, G6PD deficiency, AIDS. Renal/hepatic impairment, history of allergy or asthma. Discontinue treatment if patient develops rash. Conduct CBC and urinalyses using microscopic examination during prolonged therapy. May exacerbate lupus erythematosus. Infants <2 mth.
Adverse Reactions
Nausea, vomiting, anorexia and diarrhoea. Hypersensitivity, skin reactions; lumbar pain, haematuria, oliguria, anuria, crystallisation in urine, thrombocytopenia, leucopenia, eosinophilia, neonatal jaundice and kernicterus.
Potentially Fatal: Stevens-Johnson syndrome; agranulocytosis, thrombocytopenia, jaundice in newborn.
Drug Interactions
Potentiates antidiabetic effect of sulphonylureas. Action antagonised by PABA and procaine group of local anaesthetics. Potentiates oral anticoagulants, methotrexate and phenytoin. May decrease serum levels of ciclosporin. Ascorbic acid and hexamine may increase risk of crystalluria.
See Below for More sulfadiazine Drug Interactions
Lab Interactions
Interferes with estimation of urinary glucose, urobilinogen, urea and creatinine.
Mechanism of Actions
Sulfadiazine is a short-acting sulfonamide derivative with bacteriostatic action through competitive inhibition of bacterial synthesis of folic acid. Susceptible organisms include E.coli, Klebsiella, Enterobacter, Proteus mirabilis, P.vulgaris, S.aureus, Toxoplasma, N.meningitidis, H.influenzae.
Absorption: Readily absorbed from the GI tract. Blood concentrations peak 3-6 hr after a single dose.
Distribution: 20-55% bound to plasma proteins. Distributes into CSF within 4 hr of an oral dose.
Excretion: Half-life: About 10 hr; prolonged in renal impairment. About 50% of a single oral dose is excreted in the urine within 24 hr.
ATC Classification
J01EC02 - sulfadiazine ; Belongs to the class of intermediate-acting sulfonamides. Used in the systemic treatment of infections.
Available As
  • Sulphadiazine 1% w/w
  • Sulphadiazine 1000 mg
  • Sulphadiazine 2.70% w/w
  • Sulphadiazine 205 mg
  • Sulphadiazine 410 mg
  • Sulphadiazine 5%
  • Sulphadiazine 500 mg
  • Sulphadiazine 820 mg
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