Sulfa Family

Though far from being a drug on the market, the number of sulfa drugs has increased so rapidly during the past two years that not even doctors can keep their uses straight. In the July issue of California and Western Medicine last week, Drs. Lowell Addison Rantz and Windsor Cooper Cutting gave a brief review of the whole sulfonamide family, with the diseases on which each drug works best. The ideal sulfa drug, they said, is still to seek. Requirements: it must be as strong as possible, without poisoning the patient.

Sulfanilamide, the parent drug, was first tried on a wide variety of bacterial infections. At present its use is limited mainly to meningitis, erysipelas, urinary-tract infections. It is easy to take, "well handled by the body and excreted without difficulty," but it brings about two "exceedingly common" complications: anemia and cyanosis (lack of oxygen). On the whole, it is "less effective therapeutically than other related compounds and is being supplanted by them." It is the only sulfonamide compound which can be given rectally with success.

Sulfapyridine brings far better results than sulfanilamide, but it is a difficult drug for the body to absorb and excrete, also causes a "very troublesome nausea." At present it has a narrow range of use, for sulfathiazole is equally effective, less toxic.

Sulfathiazole is "the most important sulfonamide drug in use at present." It is a powerful weapon against pneumonia, staphylococcic infections and a great range of streptococcic infections. Resultant anemia and cyanosis are "less marked" than with the use of sulfanilamide. But sulfathiazole has other drawbacks: 1) it causes fever, skin rash, inflammation of the eyes more severely than other sulfa drugs; 2) it must be used for a relatively longer period of time, thus increasing danger of complications.

Sulfaguanidine may be of some use in dysentery and cholera but is "decidedly in the experimental stage."

Sulfadiazine seems to be "rather non-toxic." It is "very promising at the moment and may prove to be the next step in the sulfonamide ladder." (Last week Perrin Long of Johns Hopkins, top-flight sulfa specialist, announced that this drug will be on the market by early fall. Said he: "I have good reason to believe it will supplant all sulfa drugs now being used.")

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