[Sulfonamides with supposed antibacterial activity. Pharmacology of sulfamethoxydine].
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Cicatrol ointment with the formula: argentic sulphamethoxydiasine 1 g, bentonite hydrogel 12.5% for 100 g is manufactured at the Microproduction Laboratory of the Faculty of Pharmacy of Iaşi. The one-year physicochemical determinations of the aspect, colour, homogeneity, pH, rheological behaviour and relative viscosity, content in argentic sulphamethoxydiasine as well as "in vitro" antimicrobial activity of Cicatrol showed a good stability and gel properties enabling an uniform and long-term contact with the wound. The clinical investigations carried out until now in patients with burns, varicose ulcers, trophic shank ulcers, superficial phlebitis with atonic ulcerations or wounds with multiple sites revealed its remarkable therapeutic value. As compared to other similar products, Cicatrol by its aseptic properties favours the scarring of any type of wound, a normal skin, without keloid scars being obtained, it also being well tolerated.
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Internal distribution of 2-sulphanilamido-5-methoxypyrimidine (SM) 100 mg/kg in rats is characterized by a corticopapillary gradient. The papilla/cortex ratio of SM concentration averaged 2.25 +/- 0.34. Furosemide (5 mg/kg) elicited a significant corticopapillary gradient decrease for SM. Corticopapillary gradients for SM and sodium showed a positive correlation (r = 0.45; p less than 0.001). After furosemide corticopapillary gradient for SM averaged 1.4 +/- 0.22. Unilateral nephrectomy alone induced no significant difference in the corticopapillary gradient for SM compared with controls. Corticopapillary gradient for SM was significantly lower in unilaterally nephrectomized rats than in controls when furosemide was given after 24 hours or 7 or 14 days. The results suggest that SM concentration was significantly higher in the medulla than in the cortex; furosemide led to a significant decrease of corticopapillary gradient for SM against controls; the corticopapillary gradient for SM did not significantly change after unilateral nephrectomy; the effect of furosemide on corticopapillary gradient for SM was more pronounced in rats after unilateral nephrectomy than in controls.
The stability of sulphamethoxydiazine (1) in HCl (1 mol/l) under elevated temperature was investigated. Isolated decomposition products further served as standards for the selection of HPLC conditions. Three types of stationary phases were tested: Pragosil 5, MicroPak CN-10, MicroPak CH-10. The selection of mobile phases was made in such a way as to be able to inject 1 hydrolysate in HCl (1 mol/l) directly or after simple dilution. Detection was performed with an UV detector at the wavelength of 226 nm. A column packed with MicroPak CN-10 was selected to investigate the process of 1 decomposition. The method made it possible to quantify 1 in the course of hydrolysis and to illustrate the process of decomposition. On the basis of continuous examination of the development of decomposition products during the stability study it was possible to consider the chemism of the decomposition reaction.
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White mice infected intraperitoneally with the RH-strain of Toxoplasma gondii (inoculum size 50,000 to 100,000 free protozoans per mouse) received treatment between the second and eighth day after infection with sulphamethazine-pyrimethamine, sulphamethoxy-diazine-pyrimethamine, trimethoprim-sulphamethoxazole or spiramycin subcutaneously. All untreated controls and all mice of the trimethoprim-sulphamethoxazole and spiramycin-treated groups died during the acute stage (except two mice in the latter group on the 15th day). The mean survival times were 6.5, 7.5 and 7.6 days, respectively. The best results were obtained in the sulphamethazine-pyrimethamine-treated mice; 18 out of 27 survived the 30-day observation period (5 cured), in contrast to only 9 out of 40 sulphamethoxydiazine-pyrimethamine-treated mice. Considering the high pathogenicity of the RH-strain, the differences in immunological defence mechanisms in mice (absence of antibody-activating "accessory factor") and the late commencement of treatment of the infected mice, one can state that the combination of sulphamethoxydiazine-pyrimethamine should also be capable of overcoming acute human toxoplasmosis in pregnancy. Spiramycin, by contrast, should be given only in cases where sulphonamide intolerance exists and must then be given in high doses until delivery. The combination of sulphamethoxazole-trimethoprim cannot be recommended.
A pregnant 36-year-old Vietnamese refugee with chloroquine-resistant Plasmodium falciparum infection was treated with pyrimethamine and a sulfonamide. This treatment produced rapid clearance of the patient's parasitemia and was associated with a resumption of normal fetal and uterine growth. Because the other drugs effective against chloroquine-resistant P falciparum may produce uterine stimulation (quinine sulfate) or damage the fetal skeleton (tetracyclines), the pyrimethamine-sulfonamide combination (with folinic acid supplementation) may be the best available choice for the treatment and prophylaxis of chloroquine-resistant P falciparum infection in pregnancy, despite its theoretical risk of teratogenicity.
Two cases of severe sulfonamide liver injury are described. In one patient, fulminant liver failure developed after two days of taking sulfamethoxazole-trimethoprim. The patient was treated with resin hemoperfusion and recovered completely. Another patient became jaundiced after using sulfamethoxydiazine for ten days. Very severe intrahepatic cholestasis developed and cleared up only after high-dose prednison treatment. Marked hyperbilirubinemia persisted for four months and aminotransferase activity had not normalized ten months after the onset of the disease.