Sulfadimethoxine (or sulphadimethoxine, trade names Di-Methox or Albon) is a long-lasting sulfonamide antimicrobial medication used in veterinary medicine. It is used to treat many infections, including respiratory, urinary tract, enteric, and soft tissue infections[3] and can be given as a standalone or combined with ormetoprim to broaden the target range.[2] Like all sulfamides, sulfadimethoxine inhibits bacterial synthesis of folic acid by acting as a competitive inhibitor against PABA. It is the most common drug prescribed to dogs who have coccidiosis.[4]
Like other sulfonamides, sulfadimethoxine is a dihydropteroate synthase inhibitor. Bacteria and some protozoa are unable to obtain folic acid from the environment, and must instead synthesize it by converting PABA (para-aminobenzoate) to dihydropteroate using the enzyme dihydropteroate synthase. Sulfonamides act as a competitive inhibitor; being structurally similar to PABA, they are able to bind to the enzyme's active site and prevent the synthesis of folic acid from progressing. Folic acid is necessary for these organisms to produce nucleic acids (i.e. DNA and RNA), which are required for cell division.[5] Thus, it has a microbiostatic effect rather than a microbiocidal one (it prevents pathogen growth rather than killing them), and has the strongest effect in the beginning stages of an infection, when the pathogen is rapidly dividing. Since it is microbiostatic, sulfadimethoxine still requires the animal to still be able to mount an immune response to kill the pathogen.[6][3]
With ormetoprim
Sulfadimethoxine can either be given alone (such as under the commercial name Albon) or in combination with ormetoprim to as a "potentiated sulfonamide" to increase antimicrobial activity.[2] Ormetoprim is a diaminopyridine, inhibiting dihydrofolate reductase, which is further along the pathway for synthesizing folic acid. Though the optimum ratio of sulfadimethoxine to ormetoprim has been found to be 20:1, it is sold pharmaceutically as a 5:1 mixture.[6]
Pharmacokinetics
Suspension and bottle of pills of sulfadimethoxine, sold under the trade name Albon.
Sulfadimethoxine, like all sulfonamides, diffuses easily when it is in its unionized, lipid-soluble form, and easily reaches many tissues. The relative amounts are determined by both its pKa and by the pH of each tissue. Therefore, levels tend to be higher in less acidic tissue and body fluids or in diseased tissues having high concentrations of leucocytes.[7][3][6] Its ability to bind to plasma proteins is very high, leading sulfadimethoxine to maintain higher blood levels than most other long-acting sulfonamides. Comparatively low doses can give rapid and sustained therapeutic blood levels.[3] Most animals for which sulfadimethoxine is marketed acetylate sulfadimethoxine in the liver to form acetylsulfadimethoxine, which is secreted in the bile. Dogs are the exception – since they are unable acetylate sulfonamides, they excrete sulfadimethoxine mostly unchanged in the urine (their inability to transform sulfadimethoxine also makes them more susceptible to negative side effects).[8][9][10]
Sulfadimethoxine has a relatively high solubility at the pH normally occurring in the kidneys, and is easily reabsorbed into the renal tubules, adding to its long half-life.[11][8] The use of sulfadimethoxine raises concerns that it will precipitate in the kidneys, leading to crystalluria. Though crystallization is not actually a common occurrence in veterinary medicine, it can be avoided entirely by adding a diaminopyrimidine such as ormetoprim.[11][6] Having the animal stay well-hydrated also is advised.[12]
Usage
Sulfadimethoxine is the only FDA-approved drug for treating intestinal coccidioisis in cats and dogs.[2] It is also used for:
It is also one of the only sulfonamides allowed for treating lactating dairy cattle (the others being sulfabromethazine and sulfathoxypyridazine).[6]
Contraindications
Sulfadimethoxine should not be used in ""chameleon"" species as the first therapeutic dose has been shown to lead in the animals mortality. ""Caution is warranted.""
↑ Stowe CM (1965). "Chapter 33: The Sulfonamides". In Jones LM (ed.). Veterinary Pharmacology and Therapeutics. Ames, Iowa: Iowa State University Press.
1 2 3 Plumb DC (2011). Plumb's Veterinary Drug Handbook (7thed.). Ames, Iowa: Wiley. pp.951, 954. ISBN9780470959640.
↑ Papich MG (2007). Saunders handbook of veterinary drugs (2nded.). St. Louis, Mo: Saunders/Elsevier. ISBN9781416028888.
4-Aminobenzoic acid (also known as para-aminobenzoic acid or PABA because the two functional groups are attached to the benzene ring across from one another in the para position) is an organic compound with the formula H2NC6H4CO2H. PABA is a white solid, although commercial samples can appear gray. It is slightly soluble in water. It consists of a benzene ring substituted with amino and carboxyl groups. The compound occurs extensively in the natural world.
Sulfonamide is a functional group that is the basis of several groups of drugs, which are called sulphonamides, sulfa drugs or sulpha drugs. The original antibacterial sulfonamides are synthetic (nonantibiotic) antimicrobial agents that contain the sulfonamide group. Some sulfonamides are also devoid of antibacterial activity, e.g., the anticonvulsant sultiame. The sulfonylureas and thiazide diuretics are newer drug groups based upon the antibacterial sulfonamides.
Sulfamethoxazole is an antibiotic. It is used for bacterial infections such as urinary tract infections, bronchitis, and prostatitis and is effective against both gram negative and positive bacteria such as Escherichia coli and Listeria monocytogenes.
Aminopterin, the 4–amino derivative of folic acid, is an antineoplastic drug with immunosuppressive properties often used in chemotherapy. Aminopterin is a synthetic derivative of pterin. Aminopterin works as an enzyme inhibitor by competing for the folate binding site of the enzyme dihydrofolate reductase. Its binding affinity for dihydrofolate reductase effectively blocks tetrahydrofolate synthesis. This results in the depletion of nucleotide precursors and inhibition of DNA, RNA, and protein synthesis.
An antimetabolite is a chemical that inhibits the use of a metabolite, which is another chemical that is part of normal metabolism. Such substances are often similar in structure to the metabolite that they interfere with, such as the antifolates that interfere with the use of folic acid; thus, competitive inhibition can occur, and the presence of antimetabolites can have toxic effects on cells, such as halting cell growth and cell division, so these compounds are used in chemotherapy for cancer.
Coccidiosis is a parasitic disease of the intestinal tract of animals caused by coccidian protozoa. The disease spreads from one animal to another by contact with infected feces or ingestion of infected tissue. Diarrhea, which may become bloody in severe cases, is the primary symptom. Most animals infected with coccidia are asymptomatic, but young or immunocompromised animals may suffer severe symptoms and death.
Sulfadiazine is an antibiotic. Used together with pyrimethamine, a dihydrofolate reductase inhibitor, it is the treatment of choice for toxoplasmosis, which is caused by a protozoan parasite. It is a second-line treatment for otitis media, prophylaxis of rheumatic fever, chancroid, chlamydia, and infections by Haemophilus influenzae. It is also used as adjunct therapy for chloroquine-resistant malaria and several forms of bacterial meningitis. It is taken by mouth. Sulfadiazine is available in multiple generic tablets of 500 mg. For urinary tract infections, the usual dose is 4 to 6 grams daily in 3 to 6 divided doses.
Sulfanilamide is a sulfonamide antibacterial drug. Chemically, it is an organic compound consisting of an aniline derivatized with a sulfonamide group. Powdered sulfanilamide was used by the Allies in World War II to reduce infection rates and contributed to a dramatic reduction in mortality rates compared to previous wars. Sulfanilamide is rarely if ever used systemically due to toxicity and because more effective sulfonamides are available for this purpose. Modern antibiotics have supplanted sulfanilamide on the battlefield; however, sulfanilamide remains in use today in the form of topical preparations, primarily for treatment of vaginal yeast infections--mainly vulvovaginitis, which is caused by Candida albicans.
Sulfacetamide is a sulfonamide antibiotic.
Dihydropteroate is an important intermediate in folate synthesis. It is a pterin created from para-aminobenzoic acid (PABA) by the enzyme dihydropteroate synthase.
Dihydropteroate synthase (DHPS) is an enzyme classified under EC 2.5.1.15. It produces dihydropteroate in bacteria, but it is not expressed in most eukaryotes including humans. This makes it a useful target for sulfonamide antibiotics, which compete with the PABA precursor.
Tetrahydrofolic acid (THFA), or tetrahydrofolate, is a folic acid derivative.
Antifolates are a class of antimetabolite medications that antagonise (that is, block) the actions of folic acid (vitamin B9). Folic acid's primary function in the body is as a cofactor to various methyltransferases involved in serine, methionine, thymidine and purine biosynthesis. Consequently, antifolates inhibit cell division, DNA/RNA synthesis and repair and protein synthesis. Some such as proguanil, pyrimethamine and trimethoprim selectively inhibit folate's actions in microbial organisms such as bacteria, protozoa and fungi. The majority of antifolates work by inhibiting dihydrofolate reductase (DHFR).
Sulfadoxine is an ultra-long-lasting sulfonamide used in combination with pyrimethamine to treat malaria.
Difloxacin (INN), marketed under the trade name Dicural, is a second-generation, synthetic fluoroquinolone antibiotic used in veterinary medicine. It has broad-spectrum, concentration dependent, bactericidal activity; however, its efficacy is not as good as enrofloxacin or pradofloxacin.
Dihydropteroate synthase inhibitors are drugs that inhibit the action of dihydropteroate synthase. They include sulfonamides, dapsone, and para-aminosalicylic acid.
Pediococcus acidilactici is a species of Gram-positive cocci that is often found in pairs or tetrads. P. acidilactici is a homofermentative bacterium that can grow in a wide range of pH, temperature, and osmotic pressure, therefore being able to colonize the digestive tract. It has emerged as a potential probiotic that has shown promising results in animal and human experiments, though some of the results are limited. They are commonly found in fermented vegetables, fermented dairy products, and meat.
Cosequin is a nutritional supplement for animals. It claims to support joints in pets.
Oclacitinib, sold under the brand name Apoquel, is a veterinary medication used in the control of atopic dermatitis and pruritus from allergic dermatitis in dogs at least 12 months of age. Chemically, it is a synthetic cyclohexylamino pyrrolopyrimidine janus kinase inhibitor that is relatively selective for JAK1. It inhibits signal transduction when the JAK is activated and thus helps downregulate expression of inflammatory cytokines. While oclacitinib is effective, its long-term safety is currently unknown.
Polysulfated glycosaminoglycan (PSGAG), sold under the brand name Adequan, is an injectable drug for dogs and horses that is used to alleviate the limpness, pain, and lowered range of motion caused by arthritis. It is made of repeat disaccharide units (comprising hexosamine and hexuronic acid), and is similar to glycosaminoglycans already present in the cartilage; PSGAG thus easily integrates itself there. In vitro studies have shown it to inhibit the enzymes that degrade cartilage and bone, as well as suppress inflammation and stimulate the synthesis of replacement cartilage. While it can cause an increased risk of bleeding, it is relatively safe and has a high LD50. PSGAG is one of the most widely prescribed joint treatments for horses.
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