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Sulfonamides: BY Jagir R. Patel Assistant Professor
Sulfonamides: BY Jagir R. Patel Assistant Professor
BY
Jagir R. Patel
Assistant Professor
Sulfonamides
• They were the first AMAs effective against pyogenic bacterial infections
• Humans are not able to synthesize folate themselves, and exclusively rely on
absorption of folate from the GI tract
• Mammalian cells in contrast use folate receptors and folate carries in the plasma
membrane to scavenge the intact vitamin which is fundamental difference b/w
pathogen and mammalian cell which makes DHFR inhibitors an ideal target
• Folate is only active in the tetrahydrofolate (FH4) form, thus both humans and
bacteria need to activate folate to utilize it synthesis and activation of folate is
done in 3 steps
Mechanism of action
Cont…
• Sulfonamides are synthetic structural analogues of PABA and act by displacing
PABA from its binding site on dihydropteroate synthetase, thus inhibiting bacterial
synthesis of folate this leads to an inability of the bacteria to synthesize DNA and
RNA and following inability for them to divide however, bacteria are still able to
survive without dividing, thus sulfonamides are only bacteriostatic
• Since humans do not synthesize their own folate, sulfonamides leave DNA and
RNA synthesis in human cells untouched
Resistance
• Bacteria may develop resistance to sulfonamides by plasmid transfer
and/or chromosomal mutations
• Medical uses
• Treatment of cystitis due to escherichia and/or proteus Infection
• Treatment of chlamydia
• Trachoma
• lymphogranuloma due to chlamydia infection
Pharmacokinetics
• SULFAMETHOXYDIAZINE
• Side effects Same as sulfadiazine, except for urolithiasis (due to higher solubility at low
pH,
• Hypersensitivity reactions
• leading to skin rashes, angioedema and/or stevens johnson syndrome
• Drug- drug Interactions
• They inhibit the metabolism possibly display protein binding sites of phenytoin,
tolbutamide, and warfarin
• Use:
• Rarely used alone
• In chronic UTI and Gum infection
Dihydrofolate reductase inhibitors
• Dihydrofolate reductase inhibitors are structural analogues of folate and
act by competitively inhibiting dihydrofolate reductase.
• General information
• Administered orally, may cross the blood-brain barrier
• Medical uses
• Treatment of malaria due to plasmodium falciparum and/or
• plasmodium malariae, & or plasmodium vivax, and plasmodium ovale
infection
• Medical uses
• Treatment of cystitis due to escherichia and/or proteus Infection
• Treatment of pneumonia due to streptococcus and/or Haemophilus
infection
• USE
• Toxoplasmosis due to toxoplasma infection
• Malaria due to
• plasmodium falciparum, malariae, vivax and ovale and/or with aminoquinoline
Cotrimoxazole
• The fixed dose combination (1:5 according to WHO)
• Trimethoprim + Sulamethoxazole = Cotrimoxazole
• Advantage of combination:
• Individually both are bacteriostatic but combination is bactericidal
• Chances of bacterial resistance are reduced
Pharmacokinetics
• Drug interactions:
• Trimethoprim + warfarin: prolonged prothrombin time
• Plasma half life of phenytoin increases
Cotrimoxazole uses