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Mycopathologia

, Volume 108, Issue 2, pp 107–112 | Cite as

Evaluation of acetylator phenotype, renal function and serum sulfadiazine levels in patients with paracoccidioidomycosis treated with cotrimazine (a combination of sulfadiazine and trimethoprim)

  • Benedito Barraviera
  • Paulo Câmara Marques Pereira
  • Rinaldo P. Mendes
  • Jussara Marcondes Machado
  • Carlos Roberta G. Lima
  • Domingos Alves Meira
Article
  • 14 Downloads

Abstract

The authors evaluated the relationships among renal function, acetylator phenotype and serum sulfadiazine levels in 22 patients with paracoccidioidomycosis treated with 1 tablet of cotrimazine (a combination of 820 mg sulfadiazine and 180 mg trimethoprim) administered orally every 12 hours.

Fifteen patients (68.18%) presented free sulfadiazine levels above 50 μg/ml, 6(27.28%) presented serum levels above 40 μg/ml, and 1(4.54%), levels lower than 40 μg/ml, this being the patient in which treatment failed. The highest free sulfadiazine levels were obtained in slow acetylator patients with reduced renal function. One patient with neuroparacoccidioidomycosis presented free sulfadiazine levels in cerebrospinal fluid corresponding to 55% of the serum levels.

Finally, the authors consider cotrimazine to be an important therapeutic alternative for neuroparacoccidioidomycosis and conclude that administration every 12 hours can provide therapeutic sulfadiazine levels. They also suggest that when the sulfadiazine-trimethoprim combination is used, the therapeutic levels of sulfadiazine should be above 40 μg/ml.

Key words

cotrimazine sulfadiazine trimethoprim acetylator phenotype neuroparacoccidioidomycosis 

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References

  1. 1.
    Barbosa W, Daher RR. Blastomicose Sul Americana (Paracoccidioidomicose). In: Veronesi, R. Doenças Infecciosas e Parasitárias. 7 ed. Rio de Janeiro, Guanabara Koogan, 1982; p. 638–651.Google Scholar
  2. 2.
    Barbosa W. Vasconcellos WM de P.V. Ação da sulfametoxazol associada ao trimetoprim na terapêutica da Blastomicose Sul Americana. Rev Pat trop 1973; 2: 329–339.Google Scholar
  3. 3.
    Barraviera B, Mendes RP, Machado JM, Pereira PCM, Souza JM, Meira DA. Evaluation of treatment of para-coccidioidomycosis with cotrimazine (combination of sulfadiazine and trimethoprim). Rev Inst Med trop S Paulo 1989; 31: 53–5.Google Scholar
  4. 4.
    Beiguelman B. Farmacogenética e sistemas sanguíneos eritrocitários. Guanabara Koogan, Rio de Janeiro 1983; 192 p.Google Scholar
  5. 5.
    Beiguelman B, Ramalho AS, Arena JFP, Garlipp CR. A acetilação da isoniazida em brasileiros caucasóides e negróides com tuberculose pulmonar. Rev Paul Med 1977; 89: 12–15.Google Scholar
  6. 6.
    Bergan T, Brodwall EK, Vik-Mo H, Anstad U. Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function. Infection 1979; 7 (supl. 4): S382–386.Google Scholar
  7. 7.
    Bergan T, Vik-Mo H, Anstad U. Kinetics of a sulfadiazine-trimethoprim combination. Clin Pharmacol Ther 1977; 22: 211–224.Google Scholar
  8. 8.
    Bratton AC, Marshall EK. A new coupling component for sulfanilamide. J Biol Chem 1939; 128: 537–550.Google Scholar
  9. 9.
    Budel AR, Fernandes GP, Lameira RF, Telles Filho FO. Sensibilidade ‘in vitro’ do Paracoccidioides brasiliensis à associação trimethoprim-sulfametoxazol. Rev Soc Bras Med trop 1987; 20 (supl.): 76.Google Scholar
  10. 10.
    Del Negro G. Tratamento. Controle de cura. Profilaxia. In: Del Negro G, Lacaz CS, Fiorillo AM. Paracoccidioidomicose (Blastomicose Sul Americana). Sarvier, EDUSP, S. Paulo 1982; p. 271–283.Google Scholar
  11. 11.
    Drutz DJ. Paracoccidioidomycosis. In: Wyngaarden JB, Smith LH. Cecil Textbook of Medicine. WB Saunders Company, Philadelphia, 18th ed., 1988; p. 1843–1844.Google Scholar
  12. 12.
    Eidus L, Varughese P, Hodgkin MM, Hsu AHE, McRae KB. Simplification of isoniazid phenotyping procedure to promote its application in the chemotherapy of tuberculosis. Bull WHO 1973; 49: 507–516.Google Scholar
  13. 13.
    Franco MF, Montenegro MR, Mendes RP, Marques SA, Dillon NL, Motta NGS. Paracoccidioidomycosis: a recently proposed classification of its clinical forms. Rev Soc Bras Med trop 1987; 20: 129–132.Google Scholar
  14. 14.
    Guerreiro CAM, Chuluc SSD, Branchini MLN. A new treatment for large cerebral paracoccidioidomycosis. Arq Neuro-Psiquit 1987; 45: 419–423.Google Scholar
  15. 15.
    Harvey SC. Antimicrobial drugs. In: Remington's Pharmaceutical Sciences. Philadelphia College of Pharmacy and Science, 16th ed. 1980; p. 1099–1178.Google Scholar
  16. 16.
    Hodgkin MM, Eidus L, Hamilton EJ. Screening of isoniazid inactivators by dilution test. Bull WHO 1974; 51: 428–430.Google Scholar
  17. 17.
    Mandell GL, Sande MA. Antimicrobial agents. In: Goodman and Oilman's. The Pharmacological basis of therapeutics. MacMillan Publishing Company, New York, 7th ed., 1985; p. 1095–1114.Google Scholar
  18. 18.
    Mendes RP. Paracoccidioidomicose. In: Meira DA. Terapêutica de Doenças Infecciosas e Parasitárias. Rio de Janeiro, EPUME, 1987; p. 175–182.Google Scholar
  19. 19.
    Motulsky A. Pharmacogenetics. Progr Med Genet 1964; 3: 49–74.Google Scholar
  20. 20.
    Padilha-Gonçalves A. Estudo das concentrações sanguíneas das sulfonamidas no decurso do tratamento da Blastomicose brasileira. O Hospital 1946; 29: 875–881.Google Scholar
  21. 21.
    Paolucci AA. Exploração clínica da função renal. Nefrologia, Guanabara Koogan, Rio de Janeiro 1977; p. 63–71.Google Scholar
  22. 22.
    Ribeiro DO. Nova terapêutica para a Blastomicose. Publ Med (S. Paulo) 1940; 12: 36–54.Google Scholar
  23. 23.
    Snedecor GW, Cochran WG. Statistical methods. Ames. Iowa State University, 7 ed. 1980; 505 p.Google Scholar
  24. 24.
    Sunahara S, Urano M, Ogawa M. Genetical and geographical studies in isoniazid inactivation. Science 1961; 134: 1530–1531.Google Scholar
  25. 25.
    Vree TB, O'Reilly WJ, Hekster YA, Damsma JE, Van der Kleijn E. Determination of the acetylator phenotype and pharmacokinetics of some sulphonamides in man. Clin Pharmacokinet 1980; 5: 274–294.Google Scholar

Copyright information

© Kluwer Academic Publishers 1989

Authors and Affiliations

  • Benedito Barraviera
    • 1
  • Paulo Câmara Marques Pereira
    • 1
  • Rinaldo P. Mendes
    • 1
  • Jussara Marcondes Machado
    • 1
  • Carlos Roberta G. Lima
    • 1
  • Domingos Alves Meira
    • 1
  1. 1.Department of Infectious and Parasitologic DiseasesSão PauloBrazil

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