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Availability of Sulfadiazine -- United States

During December 6-12, 1992, CDC received telephone calls from pharmacies across the United States requesting sulfadiazine/trisulfapyrimidine (triple sulfa). Sulfadiazine and triple sulfa are sulfa drugs commonly used in combination with pyrimethamine for the treatment of central nervous system toxoplasmosis in patients with acquired immunodeficiency syndrome (AIDS) and newborns with congenital infections.

Because of the drug requests, a telephone survey was conducted by CDC and the Food and Drug Administration (FDA) of all pharmaceutical manufacturers approved to make these drugs and several major distributors that in the past were suppliers of the two sulfa drugs. Only one manufacturer was found; it had ceased operation in October 1992. No large inventories of either drug were available from major distributors. FDA is contacting firms to attempt to reestablish a supply of the drug expeditiously.

Until a commercial source of sulfadiazine is fully reestablished, physicians should consider using clindamycin in combination with pyrimethamine for the treatment of acute toxoplasmosis in patients with AIDS. This combination has been reported to be similar in efficacy to pyrimethamine and sulfadiazine in the treatment of acute toxoplasmic encephalitis in such patients (1,2). For secondary (maintenance) prophylaxis there is no consensus on an acceptable alternative; however, a combination approach (e.g., pyrimethamine plus sulfadoxine (Fansidar*) or pyrimethamine plus dapsone) may be better than single-agent regimens (3).

CDC has obtained a small supply of sulfadiazine/triple sulfa that will be made available to persons with acute disease who cannot tolerate clindamycin and for congenitally infected infants. Clinicians interested in obtaining a three-week supply of triple sulfa or sulfadiazine from CDC for such patients must provide CDC with an abbreviated medical history, a Toxoplasma antibody titer, and reason why clindamycin could not be used. Requests should be directed to CDC's Division of Parasitic Diseases, National Center for Infectious Diseases, daytime telephone (404) 639-4928. Reported by: J Remington, MD, Palo Alto Medical Foundation Research Institute, Palo Alto, California. Office of Generic Drugs, Div of Antiviral Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration. Scientific Resources Program, and Div of Parasitic Diseases, National Center for Infectious Diseases, CDC.

References

  1. Dannemann BR, McCutchan JA, Israelski DM, et al. Treatment of toxoplasmic encephalitis in patients with AIDS: a randomized trial comparing pyrimethamine plus clindamycin to pyrimethamine plus sulfonamides. Ann Intern Med 1992;116:33-43.

  2. Remington JS, Vilde JL. Clindamycin for toxoplasma encephalitis in AIDS {Letter}. Lancet 1991;338:1142-3.

  3. Beaman MH, Luft BJ, Remington JS. Prophylaxis for toxoplasmosis in AIDS. Ann Intern Med 1992;117:163-4.



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