Abstract
As a medical resident we have always been taught that there is some sort of cross reactivity between sulfonamide antibiotics and nonantibiotic sulfonamides. Even the manufacturer’s package inserts contain a precautionary statement about possible Cross-reactivity. The most common approach to this problem is avoidance of all sulfa containing drugs. However, there are few data supporting this contraindication. Thus we may be withholding appropriate therapies from patients unnecessarily. To provide a critical and comprehensive review of literature to explore either cross reactivity between sulfonamide antibiotics and nonantibiotic sulfonamides is a fact or fiction and to present an approach to use nonantibiotic sulfonamides in sulfa allergic patients. A PubMed and general medline search was conducted using the individual names of nonantibiotic sulfonamides. We reviewed all of the available case reports and studies regarding sulfonamide antibiotic cross-reactivity with nonantibiotic sulfonamides. Also reviewed the manufacturer’s package insert for each nonantibiotic sulfonamide drug for information concerning possible cross-reactivity with sulfonamide antibiotics. Sulfa drug allergy is one word holding the whole cross-reactivity theory in it. It should be obsolete from the medical dictionary. This one word is complicating the medical decision-making. Allergies should not be attributed to classes or groups of drugs unless proven. After reviewing all the available literature we can conclude that assumptions about cross-reactivity are a FICTION.
Highlights
Sulfonamides are commonly used drugs in primary care practice
We reviewed all of the available case reports and studies regarding sulfonamide antibiotic cross-reactivity with nonantibiotic sulfonamides
Sulfa drug allergy is one word holding the whole cross-reactivity theory in it. It should be obsolete from the medical dictionary
Summary
Reactions to Sulfonamide Antibiotics (SA) are relatively common as compared to other antimicrobials. The hypersensitivity reaction, consisting of fever and non-urticarial rash, usually develops 7-14 days after the medication initiation (Johnson et al, 2005). The term has been applied to a diverse group of drugs, all of which contain the sulfonamide chemical structure; -SO2NH2 moiety which is a part of many common medications, such as thiazide and loop diuretics (Johnson et al, 2005). Acetazolamide, Brinzolamide, Dichlorphenamide, Dorzolamide, Methazolamide, Sulthiame Bumetanide, Furosemide, Piretanide, Torsemide Bendroflumethiazide, Benzthiazide, Chlorothiazide, Chlorthalidone, Clopamide, Diazoxide, hydrochlorothiazide, Hydroflumethiazide, Indapamide, methyclothiazide, metolazone, Polythiazide, Xipamide Acetohexamide, Chlorpropamide Gliclazide, Glibornuride, Glipizide, Glimepiride, Gliquidone, Glyburide, Glymidine, Tolazamide, Tolbutamide Celecoxib, rofecoxib, valdecoxib Amprenavir, Fosamprenavir Naratriptan, Sumatriptan Amprenavir, Dapsone, Fosamprenavir, Ibutilide, Probenecid, Sotalol, Sulfasalazine, Topiramate, Zonisamide. Dymelor Diabenese Glutril Diamicron Glipizide Amaryl Glurenorm Diabeta Redul Tolinase Orinase
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