lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Solution for infusion
EXCIPIENTS:May contain Alcohol, propylene glycol, sulfites
ELECTROLYTES:May contain Sodium
▶Co-trimoxazole (Non-proprietary)
Trimethoprim 16 mg per 1 ml, Sulfamethoxazole 80 mg per
1mlCo-trimoxazole 80 mg/ 400 mg/ 5 ml solution for infusion ampoules
| 10 ampouleP£ 35. 00
▶Septrin(Aspen Pharma Trading Ltd)
Trimethoprim 16 mg per 1 ml, Sulfamethoxazole 80 mg per
1mlSeptrin for Infusion 80 mg/ 400 mg/ 5 ml solution for infusion
ampoules| 10 ampouleP£ 17. 76
Oral suspension
CAUTIONARY AND ADVISORY LABELS 9
▶Co-trimoxazole (Non-proprietary)
Trimethoprim 8 mg per 1 ml, Sulfamethoxazole 40 mg per
1mlCo-trimoxazole 40 mg/ 200 mg/ 5 ml oral suspension sugar free
sugar-free| 100 mlP£ 9. 95 – £ 9. 97 DT = £ 9. 96
Trimethoprim 16 mg per 1 ml, Sulfamethoxazole 80 mg per
1mlCo-trimoxazole 80 mg/ 400 mg/ 5 ml oral suspension|
100 mlP£ 10. 95 – £ 10. 97 DT = £ 10. 96
Tablet
CAUTIONARY AND ADVISORY LABELS 9
▶Co-trimoxazole (Non-proprietary)
Trimethoprim 80 mg, Sulfamethoxazole 400 mgCo-trimoxazole
80 mg/ 400 mg tablets| 28 tabletP£ 15. 50 DT = £ 2. 37 |
100 tabletP£ 8. 46 – £ 10. 91
Trimethoprim 160 mg, Sulfamethoxazole 800 mgCo-trimoxazole
160 mg/ 800 mg tablets| 100 tabletP£ 23. 40 – £ 23. 46 DT = £ 23. 46
Sulfadiazine 07-Feb-2018
(Sulphadiazine)
lDRUG ACTIONSulfadiazine 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.
lINDICATIONS AND DOSE
Toxoplasmosis in pregnancy (in combination with
pyrimethamine and folinic acid)
▶BY MOUTH
▶Child 12–17 years: 1 g 3 times a day until delivery
Congenital toxoplasmosis (in combination with
pyrimethamine and folinic acid)
▶BY MOUTH
▶Neonate: 50 mg/kg twice daily for 12 months.lUNLICENSED USENot licensed for use in toxoplasmosis.
IMPORTANT SAFETY INFORMATION
SAFE PRACTICE
Sulfadiazine has been confused with sulfasalazine; care
must be taken to ensure the correct drug is prescribed
and dispensed.lCONTRA-INDICATIONSAcute porphyrias p. 603
lCAUTIONSAsthma.avoid in blood disorders (unless under
specialist supervision).avoid in infants under 6 weeks
(except for treatment or prophylaxis ofpneumocystis
pneumonia) because of the risk of kernicterus.G6PD
deficiency (risk of haemolytic anaemia).maintain
adequatefluid intake.predisposition to folate deficiency
lINTERACTIONS→Appendix 1 : sulfonamides
lSIDE-EFFECTS
▶Rare or very rareHaemolytic anaemia
▶Frequency not knownAgranulocytosis.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.kernicterus (in
neonates).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 INFORMATIONDiscontinue
immediately if blood disorders (including leucopenia,
thrombocytopenia, megaloblastic anaemia, eosinophilia)
or rash (including Stevens-Johnson syndrome, toxic
epidermal necrolysis) develop.
lPREGNANCYRisk of neonatal haemolysis and
methaemoglobinaemia in third trimester; fear of increased
risk of kernicterus in neonates appears to be unfounded.
lBREAST FEEDINGSmall risk of kernicterus in jaundiced
infants and of haemolysis in G 6 PD-deficient infants.
lHEPATIC IMPAIRMENTUse with caution in mild to
moderate impairment; avoid in severe impairment.
lRENAL IMPAIRMENTUse with caution in mild to moderate
impairment; avoid in severe impairment; high risk of
crystalluria.
lMONITORING REQUIREMENTSMonitor blood counts on
prolonged treatment.lMEDICINAL FORMS
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 LABELS9, 27
▶Sulfadiazine (Non-proprietary)
Sulfadiazine 500 mgSulfadiazine 500 mg tablets| 56 tabletP
£ 190. 74 DT = £ 152. 95ANTIBACTERIALS›TETRACYCLINES AND
RELATED DRUGSTetracyclines
Overview
The tetracyclines are broad-spectrum antibiotics whose
value has decreased owing to increasing bacterial resistance.
In children over 12 years of age they are useful for infections
caused by chlamydia (trachoma, psittacosis, salpingitis,
urethritis, and lymphogranuloma venereum), rickettsia
(including Q-fever), brucella (doxycycline p. 352 with either
streptomycin p. 313 or rifampicin p. 364 ), 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 respiratory diseases (because of
their activity againstHaemophilus influenzae), and for
leptospirosis in penicillin hypersensitivity (as an alternative
to erythromycin p. 331 ).
Microbiologically, there is little to choose between the
various tetracyclines, the only exception being minocycline
p. 353 which has a broader spectrum; it is active against
Neisseria meningitidisand 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 ofBNFC 2018 – 2019 Bacterial infection 351
Infection5