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
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.
Remington JS, Vilde JL. Clindamycin for toxoplasma encephalitis
in AIDS {Letter}. Lancet 1991;338:1142-3.
Beaman MH, Luft BJ, Remington JS. Prophylaxis for toxoplasmosis
in AIDS. Ann Intern Med 1992;117:163-4.
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