[Treatment of acute otitis media]

The treatment of acute otitis media (AOM) has three main aims: to relieve pain, to control fever and in case of suppurative AOM, to overcome the bacterial infection. The two former aims are best managed with salicylates or paracetamol. The local instillation of drops of an anaesthetic-antiseptic solution in the external canal is a useful adjuvant in painful congestive viral otitis. Antibiotherapy is only indicated in suppurative AOM. The most common organisms being Haemophilus influenzae and Streptococcus pneumoniae, amoxicillin is the first line treatment. However, in children who were treated for suppurative AOM in the previous months, amoxicillin/clavulanic acid or a second generation cephalosporin is preferable. Erythromycin-sulfonamide may also be used, particularly in children who are allergic to beta-lactamines. In case of failure of the first choice antibiotic treatment, it is necessary to perform a bacteriological study of the effusion which will determine the appropriate antibiotic to be used in second hand. The duration of the antibiotic treatment must be of 8 days in the absence of spontaneous perforation, and of 10 days in case of perforation. An examination of the tympanum at 10 days is recommended in infants under 6 months of age and in children with repeated AOM. A myringostomy is only indicated when a bacteriological evaluation is needed, mainly in infants under 6 months of age, in immuno-compromised children, and in case of failure of a first line antibiotic treatment.

Antitumor effects of rhodium (II) complexes on mice bearing Ehrlich tumors

Rhodium (II) trifluoroacetate (TFARh), rhodium (II) trifluoroacetate adduct with sulfadiazine (TFARh.Sd) and rhodium (II) acetate adduct with sulfisoxazole (RhSx) were tested in mice for acute toxicity, antitumoral activity against Ehrlich ascites carcinoma and for viability of Ehrlich tumor cells in culture. At ip doses up to 60 mumol/kg (40-70 and 59 mg/kg, respectively), these compounds had no toxic effects up to 14 days. At ip doses of 10 mumol kg-1 day-1 for 5 days, TFARh and TFARh.Sd significantly increased the survival rate of mice bearing Ehrlich ascites cells (probability of survival to the end of 34th day, controls = 0.23, TFARh = 0.85, TFARh.Sd = 0.74). No significant effect was observed for RhSx. In vitro, these rhodium complexes at 40 microM significantly increased the number of dead cells in cultured Ehrlich tumor cells.

Two-layer membrane model for iontophoretic drug transport through excised rat skin

Iontophoretic and passive transport of an ionized drug (sulfisoxazole) across excised rat skin was studied using a two-chamber cell with four electrodes under successive experimental conditions: without electrical current (stage-I) and with electrical current (stage-II). Two iontophoretic/diffusion models, i.e. a one-layer membrane model and a two-layer membrane model, in which a difference in the electrical potential gradient was taken into account between the stratum corneum and epidermis/dermis layer, were constructed to describe the non-steady-state drug permeation process during ionotrophoresis. The observed iontophoretic lag-time was two times greater than the calculated value based on the one-layer membrane model. According to the two-layer membrane model, the calculated ionotophoretic lag-time agreed with the observed value. It was revealed by model adaptation to the observed data that the stratum corneum fraction of the electro-chemical potential difference across the whole skin caused by the iontophoresis was around 90%. This result was consistent with the observation that the direct current resistance of whole skin was seven times greater than that of stripped skin.

[An open randomized trial, Pediazole versus cefaclor in the treatment of acute otitis media in children]

The combination of erythromycin ethylsuccinate and acetyl sulfafuroxazole (Pediazole = ES) is effective against Hemophilus influenzae, including beta-lactamase-producing strains, and against Streptococcus pneumoniae, including macrolide-resistant strains. In this study, mean daily dosage was 40-50 mg/kg for cefaclor and 50 mg/kg ES + 150 mg/kg sulfamide for Pediazole. Both products were given in three divided doses per day for ten days. Tolerance was evaluable in 106 children and effectiveness in 103 children including 52 in the ES group and 51 in the cefaclor group. Mean age was 23.5 months and both groups were comparable as concerns age, weight, previous ENT disease, and severity of the otitis media. Tolerance was satisfactory in both groups. Clinical results were as follows: failures before or at completion of the course, 5/52 in the ES group versus 13/51 in the cefaclor for the treatment of children with acute otitis media.

Proguanil-sulphonamide for malaria prophylaxis

There are few safe, effective chemoprophylactic regimens for preventing Plasmodium falciparum infection in south-east Asia. In two randomized placebo-controlled trials, combinations of proguanil and sulphonamide were tested for chemoprophylactic activity in schoolchildren, aged 6-15 years, living near the Thai-Burmese border. Proguanil at an equivalent adult dose of 200 mg/d was combined with sulphafurazole (= sulfisoxazole) at 25 mg/kg/d or sulphamethoxazole at 25 and 10 mg/kg/d. Combinations of daily proguanil/sulphafurazole and proguanil/sulphamethoxazole were equally effective (greater than 75%) against both falciparum and vivax malaria when the sulphonamide component was used at 25 mg/kg/d. Proguanil and sulphamethoxazole at 10 mg/kg/d was ineffective. Approximately 1% of the children had sulphonamide-related skin rashes which resolved when treatment stopped. Proguanil/sulphonamide is a possible alternative chemoprophylactic regimen in areas with multiple drug-resistant P. falciparum.

Malaria prophylaxis with proguanil and sulfisoxazole in children living in a malaria endemic area

The effects of three separate antimalarial prophylactic regimens (proguanil, sulfisoxazole, and proguanil plus sulfisoxazole) and of vitamins in a control group were compared in a study population of 380 children living in a malaria endemic area along the Thai-Burmese border. The subjects, aged 5-16 years, were matched for age, weight, and presence of splenomegaly, then randomly assigned to one of the four groups. All medications were administered daily by the investigators and malaria smears were performed on a weekly basis. Among 99 subjects taking proguanil plus sulfisoxazole for a total of 1464 man-weeks, there was only one case of falciparum and no vivax malaria. Statistically, this regimen proved superior to each of the other groups against both Plasmodium falciparum and P. vivax. The data show that proguanil alone, as a causal or suppressive prophylatic, has poor efficacy against P. falciparum. Side-effects were infrequent and generally mild, except for two subjects whose sulfisoxazole prophylaxis was discontinued because of urticarial rash.

The effect of verbal commitment and treatment choice on medication compliance in a pediatric setting

This experiment examined the manner in which verbal commitment and treatment choice affect medication compliance in a pediatric setting. Parents (N = 89) of children suffering from an inner ear infection (otitis media) were asked or not asked for a verbal promise to give their child all prescribed antibiotic medication (commitment manipulation) and allowed or not allowed to choose between two equally appropriate antibiotics as the treatment for their child (choice manipulation). Self-reports at follow-up visits, which were supported by urinalysis results, indicated that obtaining a verbal commitment significantly increased medication compliance. Verbal commitment also nonsignificantly increased the likelihood of a resolved infection at follow-up. Providing the parent with a choice of treatments had no effect on compliance or health outcome.

Efficacy of oral antibiotics for the treatment of persistent otitis media with effusion

We followed 137 children who were found to have persistent otitis media with effusion (POME) one month after the diagnosis of acute otitis media. Subjects were randomly assigned to either treatment with erythromycin ethylsuccinate and sulfisoxizole or to no treatment. Follow-up utilizing pneumatic otoscopy and tympanometry showed that treated patients were more likely to have normal findings, and less likely to develop acute otitis media during the month following treatment. These data indicate that children with POME one month following acute otitis media may benefit from an additional course of antibiotics.

Erythromycin-sulfisoxazole vs amoxicillin in the treatment of acute otitis media in children. A double-blind, multiple-dose comparative study

A fixed combination of erythromycin ethylsuccinate and sulfisoxazole acetyl (erythromycin-sulfa) was compared with amoxicillin for the treatment of acute otitis media (AOM) in children. Of 145 patients studied, 76 boys and 69 girls were compliant and were evaluated for drug efficacy (72 amoxicillin, 73 erythromycin-sulfa). Based on otoscopic and tympanometric results, cure rates at ten to 14 days for AOM due to all organisms were 83% (63/72) for amoxicillin and 89% (65/73) for erythromycin-sulfa; for Haemophilus species (including mixed infections), they were 84% for amoxicillin (26/31) and 83% for erythromycin-sulfa (20/14). Cure rates for ampicillin-resistant Haemophilus were 1/1 for amoxicillin and 7/8 (88%) for erythromycin-sulfa; one patient (12%) had persistent AOM at day 10. Of the patients with AOM due to Streptococcus pneumoniae, 82% (29/35) in the amoxicillin-treated group and 98% (39/40) in the erythromycin-sulfa-treated group were cured. Patients with S pneumoniae as the initial infecting organism who were treated with amoxicillin had significantly more clinical recurrences then their erythromycin-sulfa-treated counterparts, 66% (8/12) vs 33% (3/9). There was no difference between treatment groups in recurrence rates for patients with Haemophilus as the initial infecting organism. On the treatment day indicated, the following number of patients had middle ear effusion: by days 10 to 14, 38% (27/72) amoxicillin-treated patients and 48% (35/73) erythromycin-sulfa-treated patients; by day 28, 10% (7/71) amoxicillin-treated patients and 16% (11/70) erythromycin-sulfa-treated patients. There were no significant differences in adverse reactions. The erythromycin-sulfa combination is safe and effective treatment for AOM, including ampicillin-resistant Haemophilus.

Treatment of urinary tract infections with varying regimens of sulfisoxazole

Four therapeutic regimens of sulfisoxazole were compared and contrasted with the antibody-coated bacteria test in patients with acute urinary tract infections. Of 158 college coeds who entered the study 146 completed the randomly assigned regimen. All 146 patients received 2 gm. sulfisoxazole initially and 1 gm. 4 times daily for 3 days in 44 patients (group 1), 7 days in 51 (group 2), 14 days in 29 (group 3) and 21 days in 22 (group 4). The presumptive sites of infection by the antibody-coated bacteria test were kidney (positive test) in 43 per cent of the patients and bladder (negative test) in 51.3 per cent. There was no correlation between the results of the antibody-coated bacteria test with either the presenting symptoms or the therapeutic responses. The bacteriologic cure rates at 2 days after therapy were 100 per cent in all groups and at 4 weeks after therapy they were 88.6 per cent in group 1, 86.3 per cent in group 2, 86.2 per cent in group 3 and 91 per cent in group 4. A 3-day course of sulfisoxazole was as effective as the longer regimens.

Sulfisoxazole chemoprophylaxis for frequent otitis media

Sulfisoxazole, 75 mg/kg/d in two divided doses for 3 months, was administered in a double-blind placebo crossover study to 35 children aged 6 months to 5 years who had frequent recurring episodes of otitis media. There was a 40% reduction in the rate of otitis media among patients receiving sulfisoxazole compared with those receiving placebo (0.25 v 0.42 episode per patient-month) which did not depend on age, sex, season, or several other factors. Using a randomized order, among patients who received placebo first, there was a 64% reduction on sulfisoxazole therapy compared with placebo (0.20 v 0.56 episode per patient-month). In this subgroup, there was significant improvement in eustachian tube function according to serial tympanograms. In the patients who received sulfisoxazole first, the rate of acute otitis remained low on placebo (0.28 v 0.30 episode per patient-month), and tympanogram patterns continued to improve after discontinuation of the active drug. These differences suggest a carry-over effect from the benefits of chemoprophylaxis. There was no significant difference in the species or sensitivity patterns of bacteria isolated from patients receiving sulisoxazole or placebo. Sulfisoxazole chemoprophylaxis appears to be safe and effective in significantly reducing episodes of otitis media and improving tympanogram patterns.

Therapy for acute cystitis in adult women. Randomized comparison of single-dose sulfisoxazole vs trimethoprim-sulfamethoxazole

One hundred seventeen unselected women with symptoms of acute cystitis were randomized to groups for immediate therapy with one of the following four single-dose regimens: (1) 1 g of sulfisoxazole; (2) 2 g of sulfisoxazole; (3) a combination of trimethoprim, 160 mg, and sulfamethoxazole, 800 mg; and (4) a combination of trimethoprim, 320 mg, and sulfamethoxazole, 1,600 mg. Forty-one women were excluded, 13 did not return for follow-up, and 28 did not have significant bacteriuria in the pretherapy culture. Escherichia coli was isolated in 81% of infections. Antibacterial activity was significantly greater in urine collected during the 24 hours after therapy in those who received trimethoprim-sulfamethoxazole. However, overall cure varied from 85% to 95%, without any great differences between the regimens. The rate of cure of 69% in the 13 patients with presumptive evidence of renal infection (antibody-coated bacteria present) was significantly lower than the rate of cure of 95% in women without evidence of renal infection. Single-dose therapy with these regimens was safe and effective in adult women with symptoms of acute cystitis, regardless of the localization of the site of infection.

Comparison of the disposition of total and unbound sulfisoxazole after single and multiple dosing

Plasma concentrations of total and unbound sulfisoxazole were followed after single intravenous and oral doses of 1 g sulfisoxazole and during a 500-mg, four-time-a-day dosing regimen in six healthy males, using a specific high pressure liquid chromatographic assay method. Saturable plasma protein binding was observed at total concentrations above 80-100 mg/liter. The clearance of sulfisoxazole was 18.7 +/- 3.9 ml/min for total drug and 232 +/- 64 ml/min for unbound drug. Renal elimination, on the average, accounted for 49% of the clearance of sulfisoxazole. The apparent volume of distribution for total drug was 10.9 +/- 2.0 liters and 136 +/- 36 liters for unbound drug, indicating that sulfisoxazole is primarily distributed extracellularly. Accumulation of N4-acetyl-sulfisoxazole during multiple dosing did not affect the disposition of sulfisoxazole. Adjusting for variable renal clearances between oral and intravenous administration and using the unbound plasma concentrations, the bioavailability for an oral dose of sulfisoxazole was found to be 0.95 +/- 0.04.

Efficacy of treatment regimens for lower urogenital Chlamydia trachomatis infection in women

One hundred thirteen women had Chlamydia trachomatis isolated from the cervix, or urethra, or both, were treated, and followed until failure occurred or for at least 40 days after initiation of treatment. On regimens given four times daily for 7 days, failure occurred in three (8%) of 38 on tetracycline, 500 mg, in none of five on erythromycin, 500 mg, and in three (8%) of 37 on erythromycin, 250 mg. On regimens of 500 mg given four times daily for 10 days, failure occurred in none of nine on tetracycline and in one (4%) of 24 on sulfisoxazole. Erythromycin, 500 mg, was stopped because of severe side effects. Another 10 women were given a loading dose of ampicillin plus additional ampicillin for 3 to 21 days and were followed for 4 to 76 days after treatment was stopped. Only two women remained culture positive after therapy. This study demonstrates that antimicrobial regimens that are frequently given to women in North America have significant activity against C. trachomatis.

Comparative trial of two sulfisoxazole regimens in acute urinary tract infection

Many clinicians are utilizing a 2-g loading dose of sulfisoxazole in the treatment of uncomplicated urinary tract infection. Although some of these clinicians understand the theoretical reasons for not utilizing such a treatment plan, they may be reluctant to depart from the official recommendations for sulfisoxazole because of the lack of supporting clinical data. The findings of this study provide support for the theoretical considerations outlined previously. Also, considering the potential disadvantages of the loading dose employment, for example, source of patient misunderstanding and complicated patient instructions data supporting the omission of a sulfisoxazole loading dose should be most welcome. In conclusion, the study results suggest that the inclusion of a 2-g loading dose of sulfisoxazole in the treatment of this sample of acute, uncomplicated urinary tract infections did not offer any therapeutic benefit.

Treatment of chancroid. Comparison of sulfamethoxazole-trimethoprim with recommended therapies

Thirty-five men with chancroid were randomly treated with oral sulfisoxazole, sulfisoxazole and tetracycline, sulfamethoxazole-trimethoprim, or intramuscular streptomycin. The highest rate of cures were obtained in 13 of 13 patients treated with streptomycin and in ten of ten patients treated with sulfamethoxazole-trimethoprim. Only seven of nine patients treated with sulfisoxazole and five of eight treated with sulfisoxazole and tetracycline were cured. We conclude that the sulfamethoxazole-trimethoprim combination is as efficacious as streptomycin and probably superior to sulfisoxazole and tetracycline in the treatment of chancroid.

Antimicrobial treatment of otitis media: penicillins, cephalosporins, sulfonamides

Otitis media continues to be one of the most common diagnoses made in the offices of family physicians, pediatricians, and otolaryngologists. The emergence of ampicillin resistant Hemophilus influenzae as an important etiologic agent for otitis media has altered the selection of a therapeutic antimicrobial drug. This article reviews the role of the penicillins, cephalosporins, and sulfonamides in the treatment of otitis media. Amoxicillin continues to be the drug chosen for the uncultured otitis media. Backup drugs for use in unresponsive cases include trimethoprim-sulfamethoxazole, erythromycin-sulfisoxazole, and cefaclor. The cost of the drug should be a factor in the selection when efficacy is equal.

Urine concentrations of chloramphenicol, tetracycline, and sulfisoxazole after oral administration to healthy adult dogs

Chloramphenicol, tetracycline, and sulfisoxazole were administered (orally) in separate trials to clinically healthy adult dogs of both sexes at 8-hour intervals for five consecutive 8-hour test periods. All urine was collected from each dog during each test period and an aliquot from each period was assayed for antimicrobial activity. Daily doses of the antimicrobics were as follows: chloramphenicol 99 mg/kg of body weight, tetracycline 55 mg/kg, and sulfisoxazole 66 mg/kg. Mean 8-hour urine concentrations (+/- 1SD) for chloramphenicol were 124 +/- 40 micrograms/ml; for tetracycline, 138 +/- 65 micrograms/ml; and for sulfisoxazole, 1,466 +/- 832 micrograms/ml. The mean 8-hour percentages of the doses of drug eliminated in active form in the urine were 6.3 +/- 2.6% for chloramphenicol, 11.2 +/- 2.0% for tetracycline, and 68.5 +/- 2.1% for sulfisoxazole.

Ascitic fluid modifying the distribution of sulphafurazole in rats with intestinal occlusion

In order to confirm our previous findings of increased sulphafurazole (sulfisoxazole, SF) inactivation by intestinal occlusion, SF was given intravenously 20 mg/kg to rats with a low small intestinal occlusion and to sham-operated controls 40-45 hours after the operation. Occlusion did not cause major changes in the distribution of SF to various tissues, but there were some indications of increased SF acetylation after occlusion. The occlusion rats produced ascitic fluid into the abdominal cavity and the total SF levels in the ascitic fluid were almost identical to those in blood, also after oral administration of SF, 50 mg/kg. After intraperitoneal administration of 2 ml of SF (60 microgram/ml) more SF accumulated into the small intestinal wall in occlusion rats than in controls, and the acetyl SF levels were increased in the small and large intestine. So, our previous suggestion of an increased excretory function of the large intestine in occlusion states may not be the only explanation for increased drug levels in the large intestine found after oral administration of SF. Part of the SF in the intestinal wall can also result from ascitic fluid SF, and ascites must be taken into account when considering drug pharmacokinetics.

Disseminated Mycobacterium chelonei infection: response to sulfonamides

A disseminated infection due to Mycobacterium chelonei occurred in a hemodialysis patient after rejection of his second renal transplant. Painful subcutaneous nodules and abscesses were found on both legs. Therapy with sulfisoxaxole and kanamycin produced a prompt response twice, as did sulfisoxazole alone on 2 additional occasions, despite resistance in vitro to both drugs. Clinical relapses occurred 3 times when administration of sulfisoxazole was discontinued.

Urinary tract infections treated with single dose of short-acting sulphonamide

In a prospective study 29 patients with urinary tract infections caused by sulphonamide-sensitive organisms were treated with a single oral dose of the short-acting sulphonamide sulphafurazole. Twenty-seven (93%) of the 29 patients--and possibly all 29--were cured of their infections. There was no difference in the recurrence rates after single-dose treatment and treatment for 10 days or more. Six out of eight strains of Escherichia coli causing early recurrences were sensitive to sulphonamides. These results suggest that uncomplicated infections may safely and successfully be treated by a single oral dose of a short-acting sulphonamide.

Effect of sulfisoxazole on pharmacokinetics of free and plasma protein-bound bilirubin in experimental unconjugated hyperbilirubinemia

The effect of sulfisoxazole on the time course of free (unbound) bilirubin concentrations in plasma was studied. Normal adult rats were made hyperbilirubinemic by continuous intravenous infusion of bilirubin. Sulfisoxazole was administered by either rapid intravenous injection or slow intravenous infusion, and the plasma concentrations of free and total (free plus bound) unconjugated bilirubin were determined as a function of time. Rapid injection of sulfisoxazole caused a rapid and pronounced decrease of total bilirubin concentrations in plasma but had only a transient effect on the concentration of free bilirubin. Slow infusion of sulfisoxazole caused a gradual and eventually pronounced decrease of total bilirubin concentrations in plasma but had no apparent effect on the concentration of free bilirubin at any time. These results are consistent with recently developed pharmacokinetic theory according to which the plasma clearance of total bilirubin should increase upon administration of a displacing agent while the plasma clearance of free bilirubin should remain unchanged. Bilirubin-induced encephalopathy caused by sulfisoxazole or other displacing agents may be due to very transient elevations of free bilirubin concentrations in plasma of infants with elevated plasma concentrations of total bilirubin and the consequent redistribution of the pigment to extravascular sites, including the brain.

Critical evaluation of the potential error in pharmacokinetic studies of using the linear trapezoidal rule method for the calculation of the area under the plasma level--time curve

The linear trapezoidal rule method is commonly used for the estimation of the area under the plasma level-time curve. Error analyses are performed when the method is used in first-order absorption and first-order elimination kinetics in the one-compartment system. It is found that significant underestimations and overestimations in area during the absorption phase and postabsorption phase, respectively, can occur when the method is improperly used. During the exponential postabsorption phase the relative error is only a function of the ratio (n) of the time interval over the half-life of the two plasma data points in the interval. The error from the linear trapezoidal rule method at n = 0.5 is about 1%. The error increases to 15.5% and 57.1% when n is increased to 2 and 4, respectively. It is recommended that for most absorption studies the linear trapezoidal method be used for prepeak and plateau plasma data and the logarithmic trapezoidal method for postpeak plasma data.

The clinical significant of cystitis cystica in girls: results of a prospective study

Twenty-two girls with recurrent urinary tract infection and endoscopically proved cystitis cystica were studied prospectively to determine control of infection with long-term, continuous nitrofurantoin or sulfisoxazole (6 to 12 months), effect on the bladder changes and rate of recurrence of infection after discontinuation of medication. Infection was controlled equally with both drugs but, despite adequate control, 24% had evidence of cystic changes upon completion of the treatment period. An additional 44% became reinfected during the 1-year followup with no drugs. Only one-third of those presenting with urinary frequency, urgency and urge incontinence had improvement of these symptoms with control of infection alone. It appears that childhood cystitis cystica is the response of the bladder to long-term, inadequately treated bacterial lower urinary tract infection. Many months to years of continuous medication are required for healing. Toilet retraining, in addition to anticholinergics, also may be necessary to achieve urinary control.

Evidence that sulfisoxazole, an antibacterial sulfonamide, can adversely affect the development of Brugia pahangi in Aedes aegypti mosquitoes

The average number of infective larvae recovered from Brugia pahangi-infected Aedes aegypti was approximately one-half that recovered from the controls after the former group of infected mosquitoes had ingested a 1.0% solution of sulfisoxazole diolamine (SXZ) in 10% sucrose-water for 4 consecutive days, beginning 4 days after infection. Most of the filarial larvae from the SXZ-treated mosquitoes were small and sluggish compared with those from the controls. There was no increased mortality of mosquitoes that ingested 1.0% SXZ in sugar-water for 4 days. Average filarial larval burdens were not decreased in mosquitoes that ingested a solution of 10(-6) M methotrexate (MTX), a potent dihydrofolate reductase inhibitor, in sugar-water for 4 days, beginning 4 days after infection. The distributional pattern of larval burdens in mosquitoes that ingested combined 1.0% SXZ and 10(-6) M MTX in sugar-water for 4 days closely resembled that seen in mosquitoes that had imbibed 1.0% SXZ only. Average filarial larval burdens were not decreased in mosquitoes with 4-day-old B. pahangi infections that fed upon jirds which received intraperitoneal injections of SXZ (2 g/kg) and MTX (1 mh/kh), alone and in combination, 1 hr previously. Survival of the mosquitoes that fed upon the drug-treated hosts was unaffected, as was the hatchability of their eggs and subsequent growth and development of the mosquito larvae.

Streptomycin and sulfisoxazole for treatment of Haemophilus influenzae meningitis

The increasing number of ampicillin-resistant Haemophilus influenzae recoveries have required a change in the treatment of meningitis due to this organism. Chloramphenicol has been recommended and is an effective though toxic substitute. Streptomycin combined with sulfisoxazole has been as effective as ampicillin in treating H influenzae meningitis. The results of treating 61 children with ampicillin were compared with results of those given streptomycin intramuscularly, in three intrathecal doses with sulfisoxazole intravenously, and by mouth to 50 children. Permanent neurological sequelae, including deafness, mental retardation, and persisting seizures, developed in the six given ampicillin; communic-ting hydrocephalus occurred in one who had been treated with streptomycin and sulfisoxazole. There was no phlebitis, buttocks abscess, or drug eruptions, and treatment was better tolerated in the streptomycin and sulfisoxazole group. This combination is suggested as an effective alternative to ampicillin.

Interpretation of plasma concentration-time curves after oral dosing

The pharmacokinetic information obtained after oral administration is examined using the two-compartment model. Data were obtained by simulation and experimentally by administering sulfisoxazole by an exponential infusion to rabbits. When the absorption rate constant is allowed to approach alpha, a typical two-compartment oral absorption curve is obtained, which is described by a triexponential equation. However, if the absorption rate constant approaches E2 (the sum of the elimination rate constants out of the peripheral compartment), the data are adequately fit by a one-compartment model, with the calculated absorption rate equal to alpha. The relative error in using a one-compartment model to calculate absorption rate constants for two-compartment data is also evaluated.

Differential response of chlamydial and ureaplasma-associated urethritis to sulphafurazole (sulfisoxazole) and aminocyclitols

91 men with non-gonococcal urethritis (N.G.U.) were randomly treated with either sulphafurazole (sulfisoxazole), 500 mg orally q.i.d. for 10 days, or an aminocyclitol (streptomycin or spectinomycin), 2 g intramuscularity for 1 to 3 doses at 12 h intervals. Initial urethral cultures were positive for Chlamydia trachomatis (C) in 36 (40%). Ureaplasma urealyticum (U) was isolated from the urethra or urine from20 (95%) of 21 White men in a first episode of N.G.U. who had negative chlamydia cultures. Sulphafurazole, active against C. trachomatis but not U. urealyticum in vitro, produced a clinical response in 7 of 7 men with C+U- N.G.U. and 5 of 19 with C-U+ N.G.U. (P less than 0-01). Aminocyclitols, active against U. urealyticum but relatively inactive against C. trachomatis in vitro produced a clinical response in 0 of 6 men with C+U-N.G.U., 9 of 11 men with C-U+N.G.U. from whom ureaplasma was eradicated (P less than 0-01), and 0 of 8 with C-U+ N.G.U. from whom ureaplasma was not eradicated. C+U+ N.G.U. responded poorly to both antimicrobials alone. These results support the aetiological importance of both C. trachomatis and U. urealyticum in N.G.U.

Saturable first-pass metabolism of sulfisoxazole N1-acetyl in rats

Saturable metabolism of sulfisoxazole N1-acetyl in the rat during the initial pass of the drug from the intestinal lumen through the liver following oral administration of the drug (saturable first-pass metabolism) was investigated. The fraction of the total amount of drug recovered from the urine as the N4-conjugate fraction was apparent following the intravenous administration of sulfisoxazole acetyl or the oral administration of sulfisoxazole at the same dose levels.

Sulfacytine: a new sulfonamide. Double-blind comparison with sulfisoxazole in acute uncomplicated urinary tract infections

A new sulfonamide, sulfacytine, was compared in a double-blind study with sulfisoxazole for the treatment of acute uncomplicated urinary tract infection in 98 outpatients. Patients received either 4 gm. sulfisoxazole or 1 gm. sulfacytine daily for 10 days. Evaluation was made of the bacteriologic and clinical success within the period of treatment and at some point after treatment. Bacteriologic success, or reduction of urine bacterial count from 100,000 or more micro-organisms per ml. to 1,000 or less, was observed in 95 to 100 per cent of the patients in each group during treatment as well as at the post-treatment evaluation. Clinical success, or the abolition of dysuria and frequency of urination and the reduction of pyuria to less than 10 white blood cells per high power field, was observed in 75 to 85 per cent of the patients. Adverse reactions were rare, involving 1 instance each of headache, nausea and hematuria in the sulfisoxazole group, and drug attributability was only possibly established. Mild laboratory abnormalities occurred in each group, 2 cases each of decreased white blood count and 1 instance of a lowered hemoglobin in a patient in the sulfacytine group. The results of our study seem to indicate that sulfacytine is an effective drug for the treatment of acute uncomplicated urinary tract infections.

The effect of Na benzoate on serum bilirubin of the Gunn rat

The administration of Na benzoate to grown and suckling Gunn rats in single doses of 7 and 35 mg/kg failed to significantly alter serum bilirubin concentrations. These doses are comparable to quantities of Na benzoate contained in injectable diazepam used therapeutically for newborn infants. Repeated doses of 7 mg/kg in the grown rat showed no effect, as well. A single dose of 100 or 200 mg/kg of Na benzoate and repeated doses of 35 mg/kg resulted in depressed serum bilirubin concentrations. The higher concentrations of Na benzoate, however, greatly exceed amounts contained in doses of diazepam recommended for clinical use in the human neonate. The data suggest that the use of injectable diazepam, in appropriate quantities, poses no hazard to the newborn infant in terms of bilirubin toxicity. The greater affinity for bilirubin of human albumin, than that of rat albumin, may further minimize the risk.

Reversible hydronephrosis in the neonate with urinary sepsis

Hydroureteronephrosis without vesicoureteral reflux or lower-urinary-tract obstruction is uncommon in infants. There has been considerable interest in and controversy over the cause and management of this entity. We have cared for three neonates with severe hydroureteronephrosis after acute urinary tract infections, who were treated without operation.