Skip to Content
Vaccines aren’t just for kids. Is your teen protected?

Sulfadiazine

Class: Sulfonamides
VA Class: AM650
Chemical Name: N1-2-pyrimidinylsulfanilamide
Molecular Formula: C10H10N4O2S
CAS Number: 68-35-9

Introduction

Antibacterial; intermediate-acting sulfonamide.a b

Uses for Sulfadiazine

Prevention of Rheumatic Fever Recurrence

Alternative for prevention of recurrent attacks of rheumatic fever (secondary prophylaxis).123 292 375

IM penicillin G benzathine is drug of choice for secondary prophylaxis of rheumatic fever;292 375 alternatives include oral penicillin V, oral sulfadiazine, and oral sulfisoxazole (only available in the US in fixed combination with erythromycin).292 375

AHA and AAP recommend long-term (continuous) secondary prophylaxis in patients who have been treated for documented acute rheumatic fever (even if manifested solely by Sydenham chorea) and in those with evidence of rheumatic heart disease (even after prosthetic valve replacement).292 375

Do not use for treatment of Streptococcus pyogenes (group A β-hemolytic streptococci, GAS) infections (e.g., pharyngitis and tonsillitis).123 292 375 580 Sulfadiazine will not eradicate S. pyogenes and, therefore, will not prevent sequelae such as rheumatic fever and glomerulonephritis.123 375 580

Toxoplasmosis

Treatment of toxoplasmosis caused by Toxoplasma gondii;123 134 155 156 184 185 usually used in conjunction with pyrimethamine (and leucovorin).123 134 155 156 184 185 Designated an orphan drug by FDA for use in conjunction with pyrimethamine for treatment of T. gondii encephalitis in patients with or without HIV infection.137

CDC, NIH, IDSA, and AAP recommend sulfadiazine in conjunction with pyrimethamine (and leucovorin) as the regimen of choice for initial treatment of toxoplasmosis in HIV-infected adults and adolescents155 and for treatment of acquired CNS, ocular, or systemic toxoplasmosis in HIV-infected children.156

Sulfadiazine in conjunction with atovaquone is recommended by CDC, NIH, and IDSA as one of several alternative regimens for treatment of toxoplasmosis in HIV-infected adults and adolescents who cannot tolerate or do not respond to or relapsed with the regimen of choice;155 sulfadiazine and atovaquone regimen not adequately studied for treatment of toxoplasmosis in children.156

Sulfadiazine in conjunction with pyrimethamine (and leucovorin) is the regimen of choice for treatment of congenital toxoplasmosis.156 Empiric treatment of congenital toxoplasmosis should be strongly considered if the mother had symptomatic or asymptomatic Toxoplasma infection during pregnancy, even if the mother received toxoplasmosis treatment during the pregnancy.156

Sulfadiazine used in conjunction with pyrimethamine (and leucovorin) is the regimen of choice for chronic maintenance therapy (secondary prophylaxis) to prevent relapse of T. gondii encephalitis in HIV-infected adults, adolescents, and children who have completed initial treatment of the disease.155 156

Acute Otitis Media (AOM)

Has been used in conjunction with penicillin for treatment of AOM caused by susceptible Haemophilus influenzae.123 b

When anti-infective therapy indicated for treatment of AOM, AAP recommends high-dose amoxicillin or fixed combination of amoxicillin and clavulanate as drugs of first choice for initial treatment and certain cephalosporins (cefdinir, cefpodoxime, cefuroxime, ceftriaxone) as alternatives for initial treatment in penicillin-allergic patients who do not have a history of severe and/or recent penicillin-allergic reactions.321 AAP states that sulfonamides should not be used as alternatives in patients who do not respond to amoxicillin.321

Chancroid

Has been used for treatment of chancroid caused by H. ducreyi.123 b CDC recommends azithromycin, ceftriaxone, ciprofloxacin, or erythromycin as the drugs of choice for chancroid;344 sulfadiazine not included in CDC recommendations.344

Chlamydial Infections

Has been used for treatment of infections caused by Chlamydia trachomatis (e.g., inclusion conjunctivitis, trachoma).123 Other anti-infectives (e.g., azithromycin, erythromycin) usually drugs of choice for these infections.292

Haemophilus influenzae Infections

Has been used for treatment of meningitis caused by H. influenzae as an adjunct to streptomycin.123 Other anti-infectives (e.g., ceftriaxone, cefotaxime, chloramphenicol, cefepime, meropenem, fluoroquinolones) usually recommended.506

Malaria

Has been used as an adjunct in the treatment of malaria caused by chloroquine-resistant Plasmodium falciparum.123 Not included in recommendations for treatment of malaria.134

Neisseria meningitidis Infections

Has been used for chemoprophylaxis in close contacts of individuals with invasive meningococcal disease caused by sulfonamide-susceptible Neisseria meningitidis serogroup A.123 No longer recommended because of high prevalence of N. meningitidis resistant to sulfonamides.b CDC and AAP recommend rifampin, ciprofloxacin, or ceftriaxone for such prophylaxis.292 376

Has been used for treatment of infections caused by susceptible N. meningitidis (including meningitis).123 Other anti-infectives (e.g., ceftriaxone, cefotaxime, penicillin G, ampicillin, chloramphenicol, fluoroquinolones, aztreonam) usually recommended.506

Nocardia Infections

Has been used for treatment of nocardiosis.123 292 Fixed combination of sulfamethoxazole and trimethoprim (co-trimoxazole) usually treatment of choice for Nocardia infections;197 292 some experts suggest avoiding sulfonamides that are less urine soluble (e.g., sulfadiazine).292

Multiple-drug regimens may be necessary in immunocompromised patients or those with severe or disseminated infections.292 Other drugs used alone or in multiple-drug regimens for treatment of nocardiosis include amikacin, tetracyclines, cephalosporins (ceftriaxone), carbapenems (imipenem, meropenem), fixed combination of amoxicillin and clavulanate, clarithromycin, cycloserine, or linezolid.197 292 In vitro susceptibility testing, if available, recommended to guide selection of anti-infectives for treatment of severe nocardiosis or for those who cannot tolerate or fail to respond to sulfonamide treatment.292

Plague

Has been used for treatment of plague caused by Yersinia pestis.688 May reduce mortality in patients with bubonic plague, but sulfonamides not generally recommended for pneumonic plague.688

Not considered a preferred or alternative agent for treatment of plague;197 688 sulfonamides appear to be less effective than other anti-infectives used in the treatment of plague (e.g., streptomycin, tetracycline, doxycycline).688

Urinary Tract Infections (UTIs)

Has been used for treatment of UTIs (e.g., pyelonephritis, pyelitis, cystitis) in the absence of obstructive uropathy or foreign bodies.123

Use only when UTIs are caused by susceptible Escherichia coli, Klebsiella, Enterobacter, Staphylococcus aureus, Proteus mirabilis, or P. vulgaris and only when other more soluble sulfonamides have been ineffective.123

Sulfadiazine Dosage and Administration

Administration

Oral Administration

Administer orally with a full glass (250 mL) of water.123

Maintain adequate fluid intake during therapy to minimize risk of crystalluria and stone formation.123

Dosage

Pediatric Patients

General Pediatric Dosage
Oral

Infants and children >2 months of age: Manufacturer recommends 75 mg/kg or 2 g/m2 initially, followed by 150 mg/kg or 4 g/m2 daily given in 4–6 equally divided doses.123

Children beyond neonatal period: AAP recommends 120–150 mg/kg daily given in 4–6 divided doses for the treatment of mild, moderate, or severe infections.292

Prevention of Rheumatic Fever Recurrence
Oral

Infants and children >2 months of age: Manufacturer recommends 500 mg once daily in those weighing <30 kg or 1 g once daily in those weighing >30 kg.123

AHA and AAP recommend 500 mg once daily in those weighing ≤27 kg or 1 g once daily in those weighing >27 kg.292 375

Long-term, continuous prophylaxis required.292 375 (See Adults under Dosage and Administration.)

Toxoplasmosis
Treatment of Congenital Toxoplasmosis
Oral

50 mg/kg twice daily in conjunction with oral pyrimethamine (2 mg/kg once daily for 2 days, then 1 mg/kg once daily for 2–6 months, then 1 mg/kg 3 times weekly) and oral or IM leucovorin (10 mg with each pyrimethamine dose).156

Recommended duration in HIV-infected infants is 12 months.156

Treatment of Toxoplasmosis in HIV-infected Infants and Children
Oral

25–50 mg/kg (up to 1–1.5 g) 4 times daily in conjunction with oral pyrimethamine (2 mg/kg [up to 50 mg] once daily for 3 days, then 1 mg/kg [up to 25 mg] once daily) and oral leucovorin (10–25 mg once daily).156

Treatment duration at least 6 weeks;156 longer duration may be appropriate if disease is extensive or response incomplete at 6 weeks.156

Treatment of Toxoplasmosis in HIV-infected Adolescents
Oral

1 g every 6 hours in those weighing <60 kg or 1.5 g every 6 hours in those weighing ≥60 kg in conjunction with oral pyrimethamine (200-mg loading dose, then 50 mg once daily in those weighing <60 kg or 75 mg once daily in those weighing ≥60 kg) and oral leucovorin (10–25 mg once daily; may be increased to 50 mg once or twice daily).155

Alternatively, 1 g every 6 hours in those weighing <60 kg or 1.5 g every 6 hours in those weighing ≥60 kg in conjunction with oral atovaquone (1.5 g twice daily).155

Treatment duration at least 6 weeks;155 longer duration may be appropriate if clinical or radiologic disease is extensive or response incomplete at 6 weeks.155

Prevention of Recurrence (Secondary Prophylaxis) of Toxoplasmosis in HIV-infected Infants and Children
Oral

42.5–60 mg/kg twice daily (up to 2–4 g daily) in conjunction with oral pyrimethamine (1 mg/kg or 15 mg/m2 [up to 25 mg] once daily) and oral leucovorin (5 mg once every 3 days).156

Safety of discontinuing secondary prophylaxis against toxoplasmosis in HIV-infected children receiving potent antiretroviral therapy not extensively studied.156 If child has completed initial toxoplasmosis treatment, is asymptomatic for toxoplasmosis, and has received ≥6 months of antiretroviral therapy, can consider discontinuing secondary prophylaxis in those 1 to <6 years of age if CD4+ T-cell percentages remain ≥15% for >6 consecutive months or in those ≥6 years of age if CD4+ T-cell counts remain >200/mm3 for >6 consecutive months.156

Reinitiate secondary toxoplasmosis prophylaxis if CD4+ T-cell percentages decrease to <15% in HIV-infected children <6 years of age or if CD4+ T-cell counts decrease to <200/mm3 in HIV-infected children ≥6 years of age.156

Prevention of Recurrence (Secondary Prophylaxis) of Toxoplasmosis in HIV-infected Adolescents
Oral

2–4 g daily in 2–4 divided doses in conjunction with oral pyrimethamine (25–50 mg once daily) and oral leucovorin (10–25 mg once daily).155

Criteria for initiating or discontinuing secondary prophylaxis against toxoplasmosis in adolescents are the same as those for adults.155 (See Adults under Dosage and Administration.)

Adults

General Adult Dosage
Oral

2–4 g initially, followed by 2–4 g daily in 3–6 equally divided doses.123

Prevention of Rheumatic Fever Recurrence
Oral

Adults weighing >30 kg: Manufacturer recommends 1 g once daily.123

Adults weighing >27 kg: AHA and AAP recommend 1 g once daily.292 375

AHA and AAP recommend long-term, continuous prophylaxis.292 375 (See Table 1.)

Table 1. Recommended Duration of Prophylaxis for Prevention of Rheumatic Fever Recurrence292375

Patient Category

Duration

Rheumatic fever without carditis

5 years or until 21 years of age, whichever is longer

Rheumatic fever with carditis but no residual heart disease (no valvular disease)

10 years since last episode or until 21 years of age, whichever is longer

Rheumatic fever with carditis and residual heart disease (persistent valvular disease)

10 years since last episode or until 40 years of age, whichever is longer; sometimes for life

Toxoplasmosis
Treatment of Toxoplasmosis in HIV-infected Adults
Oral

1 g every 6 hours in those weighing <60 kg or 1.5 g every 6 hours in those weighing ≥60 kg in conjunction with oral pyrimethamine (200-mg loading dose, then 50 mg once daily in those weighing <60 kg or 75 mg once daily in those weighing ≥60 kg) and oral leucovorin (10–25 mg once daily; may be increased to 50 mg once or twice daily).155

Alternatively, 1 g every 6 hours in those weighing <60 kg or 1.5 g every 6 hours in those weighing ≥60 kg in conjunction with oral atovaquone (1.5 g twice daily).155

Treatment duration at least 6 weeks; longer duration may be appropriate if clinical or radiologic disease is extensive or response incomplete at 6 weeks.155

Prevention of Recurrence (Secondary Prophylaxis) of Toxoplasmosis in HIV-infected Adults
Oral

2–4 g daily in 2–4 divided doses in conjunction with oral pyrimethamine (25–50 mg once daily) and oral leucovorin (10–25 mg once daily).155

Initiate secondary toxoplasmosis prophylaxis in all HIV-infected adults who have been treated for T. gondii encephalitis.155

Consider discontinuing secondary toxoplasmosis prophylaxis in adults who completed toxoplasmosis treatment, are asymptomatic with respect to toxoplasmic encephalitis, and have responded to antiretroviral therapy with CD4+ T-cell counts that have remained >200/mm3 for >6 months.155

Reinitiate secondary toxoplasmosis prophylaxis if CD4+ T-cell count decreases to <200/mm3.155

Nocardiosis
Oral

4–8 g daily for a minimum of 6 weeks.a Continue for several months after apparent cure to prevent relapse.a

Prescribing Limits

Pediatric Patients

General Pediatric Dosage
Oral

Maximum 6 g daily.123

Toxoplasmosis
Treatment in HIV-infected Infants and Children
Oral

Maximum 1–1.5 g per dose 4 times daily.156

Prevention of Recurrence (Secondary Prophylaxis) of Toxoplasmosis in HIV-infected Infants and Children
Oral

Maximum 2–4 g daily.156

Special Populations

No specific dosage recommendations.123

Cautions for Sulfadiazine

Contraindications

  • Hypersensitivity to sulfonamides123 or other chemically related drugs (e.g., sulfonylureas, thiazides).b

  • Infants <2 months of age (except as adjunctive therapy with pyrimethamine for treatment of congenital toxoplasmosis).123 (See Toxoplasmosis under Uses.)

  • Pregnancy at term.123

  • Nursing women.123

  • Porphyria.b

Warnings/Precautions

Warnings

Severe Reactions

Severe (sometimes fatal) reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias, reported with sulfonamides.123 b

Sore throat, fever, pallor, purpura, or jaundice may be early indications of serious reactions.123

Discontinue sulfadiazine at first appearance of rash or any sign of adverse reactions.b

Sensitivity Reactions

Hypersensitivity Reactions

Deaths associated with sulfonamide hypersensitivity reactions reported.123

Serum sickness syndrome or serum sickness-like reactions (e.g., fever, chills, rigors, flushing, joint pain, urticarial eruptions, conjunctivitis, bronchospasm, leukopenia) reported with sulfonamides.b

Various dermatologic reactions, including rash, pruritus, urticaria, erythema nodosum, erythema multiforme (Stevens-Johnson syndrome), Lyell’s syndrome (may be associated with corneal damage), Behcet’s syndrome, toxic epidermal necrolysis, and exfoliative dermatitis, reported in patients receiving sulfonamides.b

Photosensitivity reported.b

Incidence of hypersensitivity reactions appears to increase with increased sulfonamide dosage.b

Use with caution in patients with severe allergy or bronchial asthma.123

If a hypersensitivity reaction occurs during sulfonamide therapy, immediately discontinue the drug.b

Desensitization

Desensitization to sulfadiazine has been performed when use of the drug for the treatment of toxoplasmosis was considered necessary in HIV-infected patients who had a history of sulfadiazine hypersensitivity.107

Consult specialized references for specific information on desensitization procedures and dosage.107

Cross-sensitivity

Although cross-sensitization has been reported to occur between the various anti-infective sulfonamides, some diuretics such as acetazolamide and the thiazides, some goitrogens, and sulfonylurea antidiabetic agents,119 123 the association between hypersensitivity to sulfonamide anti-infectives and subsequent sensitivity reactions to non-anti-infective sulfonamides (e.g., thiazides, sulfonylurea antidiabetic agents, furosemide, dapsone, probenecid) appears to result from a predisposition to allergic reactions in general rather than to cross-sensitivity to the sulfa moiety per se.119

General Precautions

Renal Effects

Sulfonamides have been associated with renal toxicity manifested by renal colic, nephritis, urolithiasis, toxic nephrosis with anuria and oliguria, hematuria, proteinuria, crystalluria, kidney stone formation, and elevation of BUN and serum creatinine concentrations.b Nephritis and hemolytic-uremic syndrome also have been reported.b

Adverse renal effects usually are the result of crystalluria.b Risk of crystalluria may be decreased by maintaining an adequate urinary output and by increasing urinary pH.b Unless the urine is highly acidic and/or the drug is relatively insoluble, alkalinization of the urine usually is not necessary if urinary output is maintained at a minimum of 1.5 L daily.b

Perform urinalysis and assess kidney function frequently during sulfonamide therapy.b Maintain adequate fluid intake to minimize risk of crystalluria and stone formation.123 b

If persistent, heavy crystalluria, hematuria, or oliguria occurs, sulfonamide therapy should be discontinued and alkali therapy maintained.b

Patients with G6PD Deficiency

Hemolysis may occur in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency; this effect may be dose-related.123 b

Laboratory Monitoring

Perform CBCs frequently during sulfadiazine therapy.123

Perform urinalysis (with careful microscopic examination) frequently during sulfadiazine therapy, especially in patients with impaired renal function.123

Considerable interindividual variations in sulfadiazine plasma concentrations occur with a given dosage.123 Measure sulfadiazine blood concentrations in patients being treated for serious infections.123 Free sulfonamide concentrations of 5–15 mg/100 mL may be considered therapeutically effective for most infections; concentrations of 12–15 mg/100 mL may be considered optimal for serious infections.123 Do not exceed total blood concentrations of 20 mg/100 mL since adverse reactions occur more frequently above this level.123

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of sulfadiazine and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.b

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.123 b Consider that in vitro susceptibility tests are not always reliable for sulfonamides.123 If the patient is already taking sulfonamides, ensure that follow-up cultures have aminobenzoic acid added to the culture media.123

Specific Populations

Pregnancy

Category C.123

Contraindicated in pregnant women at term.123 Crosses placenta;123 may increase risk of neonatal hyperbilirubinemia and kernicterus.123

Lactation

Contraindicated in nursing women;123 discontinue drug or nursing.123

Distributed into milk;123 may cause kernicterus in the infant.123

Pediatric Use

Contraindicated in infants <2 months of age (except when considered necessary for adjunctive use with pyrimethamine for treatment of congenital toxoplasmosis).123 (See Toxoplasmosis under Uses.)

Kernicterus, caused by displacement of bilirubin from protein binding sites, has occurred in neonates treated with sulfonamides.b

Hepatic Impairment

Use with caution.123

Renal Impairment

Use with caution.123 (See Renal Effects under Cautions.)

Common Adverse Effects

GI effects (anorexia, nausea, vomiting, abdominal pain), headache, peripheral neuritis, fever, rash, pancreatitis, stomatitis, depression.123

Interactions for Sulfadiazine

Specific Drugs

Drug

Interaction

Comments

Anticoagulants, oral (warfarin)

Sulfonamides may potentiate effects of warfarin by displacing it from its protein-binding sites123 b

Closely monitorb

Antidiabetic agents

Sulfonamides may potentiate hypoglycemic effects of oral antidiabetic agents, including sulfonylurea agents123 b

Increased glucose monitoring warrantedb

Methotrexate

Sulfonamides may increase concentrations and potentiate effects of methotrexate by displacing it from protein-binding sites or inhibiting renal transport of the drug123 b

Use concomitantly with cautionb

Probenecid

May displace sulfonamides from plasma albumin and increase concentrations of free drug in plasma123

NSAIAs (indomethacin)

May displace sulfonamides from binding sites and increase concentrations of free drug in plasma123 b

Observe patient for possible adverse effectsb

Salicylates

May displace sulfonamides from plasma albumin and increase concentrations of free drug in plasma123 b

Observe patient for possible adverse effectsb

Thiazide diuretics

Sulfonamides may potentiate diuretic effects by displacing thiazide diuretics from their protein-binding sites123

Uricosuric agents

Sulfonamides may potentiate effects of uricosuric agents by displacing the agents from their protein-binding sites123

Sulfadiazine Pharmacokinetics

Absorption

Bioavailability

Readily absorbed from GI tract.123

Peak plasma concentrations attained within 3–7 hours.123 b Considerable interindividual variations in plasma sulfadiazine concentrations attained with a given dosage.123

Exists in blood as free, conjugated, and protein-bound drug; only the free form is microbiologically active.123

Distribution

Extent

Distributed into most body tissues; appears to freely cross cell membranes.a

Distributed into CSF.123 Free and total CSF concentrations may reach 32–65 and 40–60% of concurrent blood concentrations, respectively.123 Higher sulfonamide CSF concentrations may be reached if meninges are inflamed.a

Crosses placenta.123

Distributed into milk.123

Plasma Protein Binding

38–48%.123

Elimination

Metabolism

Liver; undergoes N4-acetylation (up to 40%).b

Elimination Route

Excreted principally in urine in the N4-acetylated form (about 15–40%) and unchanged (about 43–60%).123 a Approximately 50% of a single dose is excreted in the urine within 24 hours; 60–85% can be recovered within 72 hours.123 a

Half-life

About 7–17 hours.b

Stability

Storage

Oral

Tablets

20–25°C in tight, light-resistant container.123

Actions and Spectrum

  • Competitively inhibits bacterial synthesis of folic acid (pteroylglutamic acid) from aminobenzoic acid.123

  • Bacteriostatic in action.123

  • Inhibits only microorganisms that synthesize their own folic acid.b Animal cells and bacteria capable of utilizing folic acid precursors or preformed folic acid are resistant to sulfonamides.b

Advice to Patients

  • Advise patients to drink a full glass of water (250 mL) with each dose and at frequent intervals throughout the day to prevent crystalluria and stone formation.123

  • Importance of reporting the occurrence of sore throat, fever, pallor, purpura, or jaundice to a clinician since this may indicate a serious blood disorder.123

  • Advise patients that photosensitivity has been reported with sulfonamides and they should avoid exposure to UV light or prolonged exposure to sunlight.b

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.123

  • Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.123

  • Importance of advising patients of other important precautionary information.123 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Sulfadiazine

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

500 mg*

Sulfadiazine Tablets

AHFS DI Essentials. © Copyright, 2016, American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814. Review Date: September 06, 2016.

References

107. Bell ET, Tapper ML, Pollock AA. Sulphadiazine desensitisation in AIDS patients. Lancet. 1985; 1:163. [IDIS 195833] [PubMed 2857234]

119. Strom BL, Schinnar R, Apter AJ et al. Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics. N Engl J Med. 2003; 349:1628-35. [IDIS 505634] [PubMed 14573734]

123. Sandoz Inc. Sulfadiazine tablets prescribing information. Princeton, NJ; 2012 Mar.

134. Anon. Drugs for parasitic infections. Treat Guidel Med Lett. 2010; 8:e1-16.

137. Food and Drug Administration. FDA Application: Search Orphan Drug Designations and Approvals. Rockville, MD. From FDA website. Accessed 2015 Aug 4.

155. Panel on Opportunistic Infections in HIV-infected Adults and Adolescents. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America (May 7, 2013). Updates may be available at HHS AIDS Information (AIDSinfo) website.

156. Panel on Opportunistic Infection in HIV-exposed and HIV-infected children, US Department of Health and Human Services (HHS). Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics (Nov 6, 2013). Updates may be available at HHS AIDS Information (AIDSinfo) website.

184. Dannemann B, McCutchan A, Israelski D et al. Treatment of toxoplasmic encephalitis in patients with AIDS: a randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfadiazine. Ann Intern Med. 1992; 116:33-43. [IDIS 289401] [PubMed 1727093]

185. Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med. 1992; 327:1643-8. [IDIS 305877] [PubMed 1359410]

197. Anon. Drugs for bacterial infections. Med Lett Treat Guid. 2010; 8:43-52.

292. American Academy of Pediatrics. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015.

321. Lieberthal AS, Carroll AE, Chonmaitree T et al. The diagnosis and management of acute otitis media. Pediatrics. 2013; 131:e964-99. [PubMed 23439909]

344. Workowski KA, Bolan GA. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep. 2015; 64(RR-03):1-137. [PubMed 26042815]

375. Gerber MA, Baltimore RS, Eaton CB et al. Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. Circulation. 2009; 119:1541-51. [PubMed 19246689]

376. Cohn AC, MacNeil JR, Clark TA et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013; 62(RR-2):1-28. [PubMed 23515099]

506. Tunkel AR, Hartman BJ, Kaplan SL et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004; 39:1267-84. [IDIS 537717] [PubMed 15494903]

580. Shulman ST, Bisno AL, Clegg HW et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012; 55:1279-82. [PubMed 23091044]

688. Inglesby TV, Dennis DT, Henderson DA et al for the Working Group on Civilian Biodefense. Plague as a biological weapon: medical and public health management. JAMA. 2000; 283:2281-90. [IDIS 446671] [PubMed 10807389]

a. AHFS Drug Information 2016. McEvoy GK, ed. Sulfadiazine. Bethesda, MD: American Society of Health-System Pharmacists. 2016.

b. AHFS Drug Information 2016. McEvoy GK, ed. Sulfonamides General Statement. Bethesda, MD: American Society of Health-System Pharmacists; 2016.

Hide