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Drug Allergy
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Approximately 4% of the general population will develop a hypersensitivity reaction to sulfonamide antimicrobials (Jick 1982). Type I reactions are rare as most reactions consist of delayed cutaneous reactions. These drugs usually cause mild type IV drug induced exanthems, but they are also associated with life-threatening SJS/TEN and DRESS (Cribb et al. 1996). The incidence of these serious reactions is relatively low. In contrast to the general population, approximately 60% of patients with HIV develop adverse reactions to sulfonamide antibiotics. In the case of mild cutaneous drug reactions in HIV positive patients, there has been good success with desensitization protocols. There is no evidence of true cross-reactivity between sulfonamide antibiotics and non-antibiotic medications containing sulfonamide or other sulfa moieties.
Clinical pharmacology: local anesthetics
Published in Pamela E Macintyre, Suellen M Walker, David J Rowbotham, Clinical Pain Management, 2008
Jonathan McGhie, Michael G Serpell
Procaine (1905) was the first synthetic LA. Due to its low potency, slow onset, and short duration of action, it is not useful for peripheral nerve or epidural blocks but can be for skin infiltration and the 10 percent solution can be used in spinal anesthesia. It is hydrolyzed to produce para-aminobenzoic acid that inhibits the action of sulfonamide antibiotics.
Urinary tract infections in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Although TMP–SMX has been recommended as a primary treatment for uncomplicated UTIs (14), progressive bacterial resistance to it now potentially limits its effectiveness as an empiric therapy (13). The best predictor of resistance to TMP–SMX in urinary coliform bacteria is recent use of TMP–SMX (OR 5.9; 95% CI 2.4, 14.3); other predictors include diabetes, recent hospitalization, and current use of antibiotics (15). In addition to declining efficacy, safety features should also be considered before using TMP–SMX to treat UTIs during pregnancy. Both trimethoprim and sulfonamide antibiotics inhibit nucleic acid synthesis by interfering with bacterial production of folic acid. A case-control study of birth defects in the United States and Canada reported an increased likelihood of first-trimester exposure to dihydrofolate reductase inhibitors (including TMP–SMX) among women giving birth to babies with cardiovascular defects (OR 3.4; 95% CI 1.8–6.4) and oral clefts (OR 2.6; 95% CI 1.1–6.1) (16). The increased risk of cardiovascular defect associated with dihydrofolate reductase inhibitor consumption was offset in women who also took supplemental folic acid (400 mg/day). Although neonatal jaundice has occasionally been reported after fetal exposure to sulfonamides, a contemporary literature review shows no reported cases of kernicterus after such exposure (17). These findings support a recommendation to avoid TMP–SMX in both the first and late third trimesters, and to recommend a higher folic acid supplement dose (4mg/day) if TMP–SMX is prescribed in the first trimester (18).
Strain-level analysis of gut-resident pro-inflammatory viridans group Streptococci suppressed by long-term cotrimoxazole prophylaxis among HIV-positive children in Zimbabwe
Published in Gut Microbes, 2020
Ethan K. Gough, Claire D. Bourke, Chipo Berejena, Annie Shonhai, Mutsa Bwakura-Dangarembizi, Andrew J. Prendergast, Amee R. Manges
Over six decades ago, researchers first reported that sulfonamide antibiotics had beneficial effects that were not explained by their antibiotic properties.23 Other antibiotics are now known to exhibit non-antibacterial effects. Macrolides, for example, modulate pro-inflammatory cytokine secretion, promote phagocytosis of apoptotic cells, reduce neutrophil chemotaxis, enhance granule exocytosis by neutrophils, augment bactericidal activity by modulating oxidative bursts, and accelerate neutrophil apoptosis.24 The tetracyline, minocycline can exert anti-inflammatory and anti-apoptotic effects, inhibit proteolysis, and suppress angiogenesis and tumor metastasis.25 Cotrimoxazole has also exhibited immunosuppressive properties derived from the same antifolate activity that confers its antimicrobial effects.26
Oral acetazolamide for intraocular pressure lowering: balancing efficacy and safety in ophthalmic practice
Published in Expert Review of Clinical Pharmacology, 2021
Brackett et al. states that (1) the immunologic determinant of type I, immediate hypersensitivity responses, to sulfonamide antibiotics is the N1 heterocyclic ring, however non-antibiotic sulfonamides do not contain this feature; and (2) non-type I hypersensitivity responses to sulfonamide antibiotics are largely attributable to reactive metabolites produced at the N4 amino nitrogen of sulfonamide antibiotics, a structure also not found on any nonantibiotic sulfonamide[52]. Likely due to these structural differences, there are no conclusive reports documenting cross-reactivity between antibiotic sulfonamides and non-antimicrobial sulfonamides[53]. Finally, a comprehensive review by Johnson et al. found that the dogma of cross-reactivity is not supported by the data[54].