Sulfadiazine Crystalluria Revisited

Simon, Daniel I.

doi:10.1001/archinte.1990.00390220113023

Cited by 46 publications

(4 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 46 From the pH solubility diagram in Figure 2 it is apparent that ciprofloxacin solubility increases above pH 7.5. This is due to the formation of a low solubility complex which precipitates from solution, 54 – 56 these results could be extrapolated to other quinolones which are known to precipitate in alkaline solutions in the presence of certain metal cations. 27 Alarmingly, crystalluria was observed in half ( n = 3/6) of the participants administered 500 mg ciprofloxacin alongside sodium bicarbonate (42 mEq, three times daily for four doses) with additional fluid intake (not quantified).…”

Section: Resultsmentioning

confidence: 90%

See 1 more Smart Citation

Alkalising agents in urinary tract infections: theoretical contraindications, interactions and synergy

Kavanagh

2022

Therapeutic Advances in Drug Safety

View full text Add to dashboard Cite

Introduction: Alkalising agents have the potential to enhance the efficacy of many antimicrobial agents used in the treatment of Urinary Tract Infections; they also have the potential to cause significant patient harm if used incorrectly. This work seeks to illustrate and quantify these risks and synergies by modelling drug solubility and supersaturation against pharmacokinetic data for commonly used antibiotic agents. Methods: Solubility-pH relationships are employed to quantify the crystalluria risk for compounds which may be reasonably expected to be co-prescribed—or co-administered—with urinary alkalisers (amoxicillin, nitrofurantoin, trimethoprim, sulfamethoxazole and ciprofloxacin). These results are correlated against reports of crystalluria in the literature and in the EU Adverse Drug Reaction database. Results and Discussion: We find a correlation between the maximum theoretical supersaturation attainable and crystalluria reports for sulfamethoxazole, amoxicillin and ciprofloxacin. Shifts in urine pH which can be induced by alkalising agents may produce supersaturated states (and thus induce crystalluria) and may also affect antimicrobial efficacy. The importance of employing biorelevant media to improve predictive capacity of this analysis is also discussed. Conclusion: Despite their widespread use, alkalising agents have significant effects on the pharmacokinetics of the most common drugs used to treat UTIs. With self-care set to increase, all OTC products should be critically re-evaluated to ensure patient safety, particularly within contexts where healthcare professionals are not involved in treatment selection. This analysis suggests a need for consistency across patient and healthcare professional documents to improve clarity. Plain Language Summary OTC Alkalising agents need additional warning information Alkalising agents (e.g., sodium and potassium citrate) can be purchased in many locations without the supervision of a healthcare professional. Although they are thought as innocuous agents, alkalisers can greatly influence the way some antibiotics behave in the body and this can potentially cause patient harm. This work illustrates these risks and synergies by modelling drug solubility and supersaturation against pharmacokinetic data for commonly used antibiotic agents. Manufacturers and patients should be aware that the use of alkalising agents with these drugs (and potentially many others) may cause unintended consequences.

show abstract

Section: Resultsmentioning

confidence: 90%

“… 49 This is unsurprising, as crystalluria is a common feature of sulfonamide antibiotics and is associated with urine pH < 7. 9 , 50 – 52 Amoxicillin induced crystalluria is also well characterised and has been widely reported, 8 , 23 , 45 it is associated with acidic urine around pH 5. 23 …”

Section: Resultsmentioning

confidence: 99%

Alkalising agents in urinary tract infections: theoretical contraindications, interactions and synergy

Kavanagh

2022

Therapeutic Advances in Drug Safety

View full text Add to dashboard Cite

show abstract

“… 4 High-dose sulfadiazine induces crystalluria in 20%–45% of patients; however, its association with obstructive nephropathy is rare, ranging from 0.4% to 5.4% of these patients. 5 , 6 The crystal deposition is enhanced by dehydration, hypoalbuminemia, chronic kidney disease, inadequate high doses, and acidic urinary pH (<5.5). Therefore, treatment involves cessation of the sulfadiazine with possible switching to a trimethoprim–sulfamethoxazole regimen, aggressive volume repletion, and urine alkalization at a pH of >7.15.…”

Section: Discussionmentioning

confidence: 99%

Sulfadiazine-Induced Obstructive Nephropathy Presenting with Upper Urinary Tract Extravasation

Kabha

Dekalo

Barnes

et al. 2016

Journal of Endourology Case Reports

View full text Add to dashboard Cite

Background: Obstructive nephropathy is an uncommon side effect of sulfadiazine, which is used for the treatment of toxoplasmosis. We present a case of acute renal colic and urine extravasation of a patient shortly after she was started on this medication.Case Presentation: A 31-year-old female presented with acute renal colic 2 weeks after starting treatment with sulfadiazine and pyrimethamine for ocular toxoplasmosis.Results: A noncontrast computed tomography revealed left hydronephrosis and fluid located around the kidney and in the left gutter. There were no urinary stones. Administration of intravenous contrast revealed significant urine extravasation at the level of the ureteropelvic junction. Intravenous contrast injection confirmed that the extravasation consisted of urine leakage at the ureteropelvic junction. Her clinical condition improved with the insertion of an internal stent, which was left in place for 4 weeks. A retrograde pyelography performed at the time of the internal stent removal ruled out persistent extravasation and filling defects in the left upper urinary tract. Considering the clinical circumstances and the imaging results, it appears that this is a first reported case of sulfadiazine-induced obstructive uropathy associated with urine extravasation.Conclusion: Although rare, obstructive uropathy related to sulfadiazine medication should be promptly suspected, diagnosed, and treated. Patients should be instructed to substantially increase their liquid intake while on that medication.

show abstract

“…Acute renal failure due to crystal deposition of sulfadiazine in the urinary tract will be of growing concern if appropriate prophylactic measures are not taken promptly. 99 Molina et u Z .~O O reported four cases of AIDS patients with toxoplasmic encephalitis who developed sulfadiazine-induced crystalluria after receiving a combination of sulfadiazine and pyrimethamine. The crystalluria was rapidly reversed by rehydration and urine alkalinization.…”

Section: Gonzalez-clemente Et ~2 2 ~~mentioning

confidence: 99%

Opportunistic/nosocomial infections. Treatment and developmental therapeutics. Toxoplasmosis

Georgiev

1993

Medicinal Research Reviews

View full text Add to dashboard Cite

Sulfadiazine Crystalluria Revisited

Cited by 46 publications

References 6 publications

Alkalising agents in urinary tract infections: theoretical contraindications, interactions and synergy

Alkalising agents in urinary tract infections: theoretical contraindications, interactions and synergy

Sulfadiazine-Induced Obstructive Nephropathy Presenting with Upper Urinary Tract Extravasation

Opportunistic/nosocomial infections. Treatment and developmental therapeutics. Toxoplasmosis

Contact Info

Product

Resources

About