Studies in dogs and cats dosed with trimethoprim and sulphadiazine

Bioavailability and Pharmacokinetics of Sulphadiazine, N4-acetylsulphadiazine and Trimethoprim following Intravenous and Intramuscular Administration of a Sulphadiazine/Trimethoprim Combination in Sheep

The combination of sulphadiazine and trimethoprim is extensively used in farm animal species; however, there are no data concerning its pharmacokinetics after intramuscular administration in sheep. Twelve rams of the Chios breed were used to study the disposition of sulphadiazine, its metabolite N4-acetylsulphadiazine and trimethoprim after intravenous (i.v.) and intramuscular (i.m.) administration of a sulphadiazine/trimethoprim (5:1) combination in sheep. Sulphadiazine bioavailability (+/-SD) was 69.00%+/-10.51%. The half-life of the terminal phase (4.10+/-0.58 h after i. v., and 4.03+/-0.31 h after i.m. administration) was significantly higher than the respective value for trimethoprim (0.59+/-0.19 h) after i.v. administration. The maintenance of a constant plasma concentration ratio after i.v. administration was therefore impossible. The acetylation capacity in sheep, determined by the AUC ratio between N4-acetylsulphadiazine and the parent compound, sulphadiazine, was very low (less than 4%). The most remarkable finding of this study was that trimethoprim was not detected in sheep plasma after i.m. injection. In conclusion, according to the findings of the present study, following i.v. administration of the sulphadiazine/trimethoprim combination, trimethoprim can be considered as the limiting factor for any possible synergistic effect, and the i.m. route cannot be recommended in sheep.

Idiosyncratic toxicity associated with potentiated sulfonamides in the dog

Idiosyncratic toxicity to potentiated sulfonamides occurs in both humans and dogs, with considerable clinical similarities. The syndrome in dogs can consist of fever, arthropathy, blood dyscrasias (neutropenia, thrombocytopenia, or hemolytic anemia), hepatopathy consisting of cholestasis or necrosis, skin eruptions, uveitis, or keratoconjunctivitis sicca. Other manifestations seen less commonly include protein-losing nephropathy, meningitis, pancreatitis, pneumonitis, or facial nerve palsy. The pathogenesis of these reactions is not completely understood, but may be due to a T-cell-mediated response to proteins haptenated by oxidative sulfonamide metabolites. Our laboratory is working on tests to characterize dogs with possible idiosyncratic sulfonamide reactions, to include ELISA for anti-drug antibodies, immunoblotting for antibodies directed against liver proteins, flow cytometry for drug-dependent anti-platelet antibodies, and in vitro cytotoxicity assays. The management of idiosyncratic sulfonamide toxicity involves client education to identify clinical signs early and allow rapid drug discontinuation, supportive care to include possibly ascorbate and glutathione precursors, and avoidance of subsequent re-exposure. It is important to realize that only antimicrobial sulfonamides, such as sulfamethoxazole, sulfadiazine, and sulfadimethoxine, share this clinical syndrome. There is no evidence for cross-reactivity with drugs that have different underlying structures but share a sulfonamide moiety, such as acetazolamide, furosemide, glipizide, or hydrochlorthiazide.

Aplastic anemia associated with prolonged high-dose trimethoprim-sulfadiazine administration in two dogs

Trimethoprim-sulfadiazine (TMP-SDZ) (Tribressin tablets 120 - 100 mg sulfadiazine, 20-mg trimethoprim [Coopers Animal Health, Inc., A Pitman-Moore Company, Mundelein, Ill.]) is a broad spectrum antibiotic combination effective in the treatment of bacterial pneumonia, urinary tract infections, pyoderma, meningitis, and prostatitis.(1) In clinical trials in puppies and adult dogs, TMP-SDZ was considered safe at both the manufacturer's recommended dose (15 mg/kg, b.i.d., or 30 mg/kg, u.i.d., per os for < 14 days(2)) and at 10 times that dose for 20 dayS.(3) Many infections, however, require prolonged high-dose therapy for resolution. The following study describes two cases of aplastic anemia and sepsis associated with intermittent, chronic (17-25 days), high-dose (25-30 mg/kg, b.i.d., per os) TMP-SDZ therapy recommended for the treatment of pyoderma.(4-7)

Case control and historical cohort study of diarrhea associated with administration of trimethoprim-potentiated sulphonamides to horses and ponies

Trimethoprim-potentiated sulphonamides (TPS) are among the most frequently administered antimicrobials in equine medicine. Anecdotally, TPS has been implicated as a cause of mild to moderate diarrhea in horses. The purpose of this study was to document the prevalence of diarrhea in horses receiving TPS, to characterize the severity of the diarrhea, and to identify any other factors associated with the development of diarrhea. A 2-part study was designed to identify the prevalence of diarrhea associated with TPS in our clinic population. Part I was a case-control retrospective study of 135 records over a 10.5-year period from January 1, 1980 through June 30, 1990. Part II was a historical cohort study of 784 records over a 37-month period from July 1, 1990 through July 31, 1993. There was no significant difference in the occurrence of diarrhea associated with TPS therapy in either study. The occurrence of diarrhea was 21% and 3% in parts I and II, respectively. Significant factors identified in association with diarrhea in part I were duration of hospital stay, and antibiotic therapy other than TPS or penicillin. Significant factors identified in part II included other antibiotic therapy, penicillin therapy, and combined penicillin and TPS therapy. Diarrhea does occur after the administration of antibiotics, most likely because of the alteration of the patient's normal intestinal flora. Diarrhea was noted in association with administration of TPS in this study; however, its prevalence was not significantly different than that in horses receiving other antibiotics, such as penicillin and its derivatives.

Plasma concentration and disposition of antimicrobial agents in the dog

Although there is sufficient information on the pharmacology and therapeutic application of the antimicrobial drugs to permit their effective use, they are still often misused in canine practice. This paper collates the data on drug dose rate/plasma concentration relationships observed in dogs after the administration of specific members of the major antimicrobial drug groups and on the possible impact of drug disposition (distribution and elimination) on therapeutic effect. Some information gleaned from studies in other animal species is added.