Sodium Sulfacetamide For Ocular Infections: A Comprehensive Review

Overview:

An antibiotic called Sodium sulfacetamide is used topically to treat bacterial infections, especially those that damage the skin and eyes. The FDA (Food and Drug Administration) approved using sodium sulfacetamide in 1996. Sulfacetamide sodium is an anti-infective substance that is used orally to treat urinary tract infections and applied topically to treat skin infections. One kind of sulfonamide antibiotic is Sulfacetamide. All isolated isolates can have their growth inhibited by Sulfacetamide. Sodium sulfacetamide worked well at concentrations of 0.006 to 6.4 percent, depending on the kind of bacteria.

Drug Group:

Sodium sulfacetamide is a member of the sulfonamide medicine class. A class of synthetic antimicrobial drugs known as sulfonamides prevents bacteria from growing by obstructing the production of folic acid, which is necessary for the bacteria to make DNA (deoxyribonucleic acid) and RNA (ribonucleic acid).

Available Doses and Dosage Forms:

Forms of Dosage:

• Eye Drops: Liquid formulations called eye drops are administered directly to the eye. Frequently, they are packaged in tiny dropper vials for convenient dosing.

• Eye Ointment: Applied to the inner of the lower eyelid. As it is thicker in consistency, it offers an extended duration of contact with the ocular surface.

Available Doses: Ten percent Sodium sulfacetamide is one of the commonly available dosages; however, this can change.

For Patients:

What Is Ocular Infections?

Infections affecting the eye or the tissues around it are called ocular infections. Numerous microorganisms, such as bacteria, viruses, fungi, and parasites, might cause them. These can include ailments like keratitis (corneal inflammation), conjunctivitis (pink eye), and other infectious or inflammatory eye disorders. Redness, irritation, discharge, and impaired vision are possible symptoms. Antibiotics are frequently used in the treatment of bacterial eye infections.

How Does Sodium Sulfacetamide Work?

One antibiotic that acts by preventing bacterial growth is Sodium sulfacetamide. It is an antibiotic that is a member of the sulfonamide class. Folic acid production, which is necessary for bacterial growth, is hampered by Sulfacetamide. Sodium sulfacetamide efficiently kills or stops the growth of susceptible bacteria that cause the infection by interfering with this mechanism.

What Is the Dosage of Sodium Sulfacetamide?

They are available in the form of liquid formulations called eye drops and thicker formulations called eye ointments.

• Ocular Solution: Apply one to three drops to the lower conjunctival sac (lower lid pouch) every two to three hours.

• Ocular Ointment: Apply a small quantity one to four times a day, as well as before bed, to the lower conjunctival sac.

How Effective Is Sodium Sulfacetamide?

In general, Sodium sulfacetamide works well against a variety of bacteria that can lead to eye infections. Depending on the particular bacteria causing the infection, its effectiveness may differ. To guarantee the eradication of the germs and stop the emergence of antibiotic resistance, it is crucial to take the medicine as directed and finish the whole course of therapy.

In addition, the patient's general health, the extent of the illness, and whether the infection is brought on by susceptible bacteria can all affect how successful Sodium sulfacetamide is.

What Are the Things to Inform the Doctor Before Taking the Drug?

• If the person has allergies to Sulfacetamide, sulfa medicines, Sulfites, or other medications, let the doctor and chemist know.

• Tell about all the prescription and over-the-counter medications presently used, including any vitamins and other eye medications.

• Taking Sulfacetamide while pregnant, nursing a baby, or want to become pregnant, let the doctor know right away.

• Be advised that during treatment, Sulfacetamide eye ointment may cause impaired vision. Avoid touching the eyes, even if the vision is blurry.

• Avoid using machinery or driving if the vision is impaired.

• Tell the physician about wearing soft contact lenses on a regular basis. Soft contact lens insertion should be postponed by at least 15 minutes if the Sulfacetamide brand includes Benzalkonium chloride.

How Is Sodium Sulfacetamide Administered?

Ophthalmic Sulfacetamide is available as an ointment to be used topically and as a solution (liquid) to be injected into the eyes. The ointment is often applied four times a day and at bedtime; the eye drops are typically administered every two to three hours during the day and less frequently at night.

1. To Administer the Eye Drops, Take the Following Actions:

• Use soap and water to give the hands a thorough wash.

• Verify that the dropper tip is not broken or chipped by checking it.

• Eye drops and droppers need to be kept clean; avoid pressing the dropper tip up against the eye or anything else.

• Using the index finger, create a pocket by pulling down the bottom eyelid while tilting the head back.

• With the other hand, hold the dropper with the tip down as close to the eye as possible without touching it.

• Place the hand's remaining fingers up against the face.

• Squeeze the dropper carefully so that one drop enters the lower eyelid's pocket while gazing up.

• Take off the index finger from the lower eyelid.

• For two to three minutes, close the eyes and tilt the head downward as if staring at the ground. Make an effort not to squint or compress the eyes.

• Gently push a fingertip against the tear duct.

• Using a tissue, remove any extra liquid from the face.

• Wait at least five minutes before applying the next drop if planned to use more than one in the same eye.

• Reinstall and tighten the dropper bottle's cap. Do not clean the tip of the dropper.

• Hand-wash to get rid of any drug residue.

2. To Use the Eye Ointment, Adhere to the Following Guidelines:

• Use soap and water to give the hands a thorough wash.

• It is important to keep the tube tip clean; therefore, avoid brushing it against the eyes or anything else.

• Place the tube as close to the eyelid as possible without touching it while holding it between the thumb and fingers.

• Place the hand's remaining fingers up against the face.

• Lean the head back a little bit.

• To create a pocket, use the index finger to draw down the lower eyelid.

• Squeeze a ribbon of ointment about a quarter to a half inch (0.6 to 1.25 centimeters) into the pocket created by the lower eyelid. The index finger should come off the lower eyelid.

• After slowly blinking, softly close the eye for a duration of one to two minutes.

• Remove any extra ointment from the lashes and eyelids with a tissue. Wipe the tube's tip clean with another piece of clean tissue.

• Immediately replace and tighten the cap.

• Hand-wash to get rid of any drug residue.

What Are the Side Effects of Sodium Sulfacetamide?

• Temporary stinging and burning in the eyes.

• Headache.

• Hypersensitivity (photosensitivity, erythema, rash, itching, and swelling).

• Severe Reactions (Rare)- Nephrotoxicity (kidney infection) with high dermatologic concentrations, superinfection, Stevens-Johnson syndrome (a disorder of mucous membrane and skin), and drug-induced lupus erythematosus (an autoimmune condition that can impact the skin, joints, kidneys, brain, and other organs).

Dietary Considerations:

There are no dietary interactions or restrictions. While using this medicine, follow any dietary recommendations given by the doctor. For information on any dietary restrictions or concerns that could be relevant while undergoing treatment, speak with the doctor.

Missed Dose:

Take the missing dosage as soon as remember. On the other hand, skip the missed dosage and go back to the usual dosing plan if the next scheduled dose is almost here. Do not take two doses to make up for one that is missed. See the doctor for advice if unsure or if more than one dose is skipped.

Overdose:

If overdosed, get help right away from a medical professional or call a poison control center. A medicine overdose can have detrimental effects on one's health. Moderate to severe erythema (redness) and moderate edema (raised kin) are among the side effects, along with headache, nausea, vomiting, dizziness, and fatigue. Increased exposure leads to unconsciousness. Recognize the symptoms of an overdose, which include extreme vertigo, trouble breathing, or unconsciousness. Make sure to always have the emergency services' contact information on hand.

Storage:

• Keep this medication out of children's reach and in the sealed container it came in. Keep it out of the bathroom and at room temperature, away from sources of heat and moisture. Keep it from freezing, and avoid using eye drops that are discolored (from yellow to deep reddish brown).

• It is important to dispose of unnecessary prescriptions in a certain manner so that children, dogs, and other people cannot ingest them.

• Since many prescription containers (including weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and are readily opened by small children, it is crucial to keep all medication out of children's sight and access. Always lock safety caps on medications to prevent poisoning in small children, and store them right away in a secure spot that is out of their reach and sight.

For Doctors:

Indication:

Sodium sulfacetamide is a sulfonamide class medicine that is mostly used for its antibacterial qualities. It can take many different forms, such as:

• Ophthalmic Solutions: Used to treat infections of the superficial eye, such as conjunctivitis.

• Washes and Lotions: Used to treat mild to moderate cases of acne vulgaris.

• Creams and Shampoos: Used to treat dandruff and seborrheic dermatitis.

Dose:

• Regarding Conjunctivitis and Further External Ocular Infections: First, apply one or two drops every two to three hours to the conjunctival sac of the afflicted eyes. As the disease improves, dosages can be reduced by lengthening the time between doses. Treatment typically lasts seven to ten days.

• Regarding Trachoma: Every two hours, apply two drops to the conjunctival sac(s) of the afflicted eye(s). Systemic administration needs to go hand in hand with topical administration.

Dosing Considerations:

Always take the medicine as directed by the doctor or according to the label.

If having an allergy to sulfonamides, avoid using Sodium sulfacetamide.

Notify the physician of any additional drugs used, as there can be possible interactions.

Use with caution in women who are nursing or pregnant.

If a person feels any burning, stinging, redness, or swelling at the application site, stop taking the drug and see the doctor.

What Are the Pharmacological Aspects of Sodium Sulfacetamide?

1. Pharmacodynamics

• Antibacterial Activity: Sodium sulfacetamide has antibacterial activity against a variety of susceptible bacteria. It prevents bacteria from synthesizing folate, which is essential to their development and reproduction.

• Range of Activity: Both gram-positive and gram-negative bacteria can be successfully combated by it. Ocular infection-causing microorganisms fall within the antibacterial range.

• Bacteriostatic Effect: Sodium sulfacetamide usually has a bacteriostatic effect, which means that it stops bacteria from growing instead of killing the bacterium.

2. Mechanism

According to the Woods-Fildes theory, Sulfacetamide is a competitive inhibitor of bacterial para-aminobenzoic acid (PABA), a necessary component for bacterial development. In these species, the production of folic acid requires a blocked reaction.

• Preventing the Synthesis of Folates: Dihydropteroate synthase is an enzyme that is essential for the production of bacterial folate, and its inhibition is the main mechanism of action. The growth and multiplication of bacteria are hampered by this disturbance in folate synthesis.

• Folic Acid Antagonist: Para-aminobenzoic acid (PABA), a precursor to folic acid, is competitively inhibited by Sodium sulfacetamide. It prevents the creation of vital elements required for bacterial DNA and protein synthesis by obstructing this route.

3. Pharmacokinetics

• Absorption: Systemic absorption is low when used topically as eye drops or ointments. The drug mostly affects the tissues in the eyes locally.

• Distribution: Sodium sulfacetamide is mostly found in the tissues of the eyes, where it has antibacterial properties.

• Metabolism and Excretion: Sodium sulfacetamide has a restricted metabolism and is mostly excreted through the kidneys.

• Half-Life: Depending on variables like renal function, the elimination half-life might differ between people.

• Administration Route: Usually, eye drops or ointments containing Sodium sulfacetamide are applied topically to the eyes.

Toxicity:

• Local Irritation: If the drug comes into contact with sensitive tissues, it may cause local irritation. This may seem like soreness, burning, or redness. It could be important to seek medical assistance if there is a serious irritation.

• Hypersensitivity Responses: Sodium sulfacetamide exposure can cause allergic responses in those who are hypersensitive or allergic to sulfonamides. Severe allergic responses, including anaphylaxis, are rare but require prompt medical attention.

• Systemic Absorption: Topical application has very little systemic absorption; nevertheless, repeated or excessive application may result in increased absorption and systemic effects. It's crucial to keep an eye out for indicators of systemic toxicity.

Clinical Studies:

Efficacy Study:

• 1982 Study: In 155 individuals with bacterial conjunctivitis, a double-blind, multi-center experiment assessed the effects of Chloramphenicol 0.5 percent eyedrops vs Sodium sulfacetamide 10 percent eyedrops. Similar results were seen in both groups' ability to eradicate germs and resolve symptoms, indicating the potential benefit of Sodium sulfacetamide as a substitute medication.

Studies on Safety:

• 1965 Research: One hundred healthy participants were used in this investigation to assess the ocular tolerance of a 10 percent solution of Sodium sulfacetamide. The absence of notable irritation or sensitization was observed, indicating the safety of the product for topical ophthalmic usage.

• Study From 1972: After topical ocular treatment, researchers evaluated the systemic absorption of Sodium sulfacetamide in 12 healthy participants. The study's little systemic absorption finding adds credence to the product's safety profile.

What Are the Contraindications of Sodium Sulfacetamide?

• Hypersensitivity: People with a documented sulfonamide allergy or hypersensitivity should not use Sodium sulfacetamide.

• Porphyria: Because Sodium sulfacetamide may aggravate porphyria, a rare group of hereditary illnesses affecting the skin or neurological system, patients with a history of these problems may be advised not to use this medication.

• Use in Infants: It is not advised to use certain formulations on infants due to the presence of certain components. It's crucial to review the contraindications for the particular product.

• Known Sensitivity to Benzalkonium Chloride: People who are known to be sensitive to this component may require a different medicine if the Sodium sulfacetamide product contains benzalkonium chloride.

• Enzyme Deficiency: Glucose-6 phosphate dehydrogenase deficiency (a rare enzyme deficiency).

Warnings and Precautions:

Warnings:

• This is only for topical eye use; do not inject.

• Rarely, but fatalities have happened as a result of severe reactions to Sulfonamides, such as toxic epidermal necrosis, fulminant hemolytic necrosis, anemia, agranulocytosis, and other blood disorders. No matter which way a Sulfonamide is delivered again, sensitizations could happen again.

• There have been cases of sensitivity responses in people who had never experienced Sulfonamide hypersensitivity before.

• Use of this preparation should be stopped at the first sign of hypersensitivity, skin rash, or other significant response.

Precautions:

• Extended use of topical antibacterial medicines may lead to non-susceptible organisms, such as fungi, overgrowing. Additionally, bacterial resistance to sulfonamides might emerge.

• Purulent exudates containing para-aminobenzoic acid may decrease the efficacy of Sulfonamides.

• No matter which way a Sulfonamide is delivered again, sensitization may reappear, and there may be cross-sensitivity between several sulfonamides.

• The patient should stop taking the drug and see a doctor at the first indication of hypersensitivity, an increase in purulent discharge, or a worsening of inflammation or discomfort.

What Are the Drug Interactions of Sodium Sulfacetamide?

1. Moderate Interaction:

• Silver Nitrate Ophthalmic: Taking these two eye treatments together may make one more likely to have eye irritation and slow down the healing of wounds. Generally speaking, it's suggested against utilizing them together.

2. Minor Interactions:

• Sodium sulfacetamide may somewhat slow down the rate at which Benzylpenicillin is excreted, which might result in elevated blood levels. In most circumstances, this interaction is not anticipated to have a substantial clinical impact.

• Methemoglobinemia is a rare illness that lowers the blood's capacity to carry oxygen. Bupivacaine, Butacaine, Butamben, Capsaicin, Cinchocaine, Cocaine, Diphenhydramine, Mepivacaine, and Prilocaine, together with Sodium sulfacetamide, can raise the risk of this condition. Unless one also has additional methemoglobinemia risk factors, this risk is often modest.

• Cisatracurium has the ability to relax muscles. Exercise caution and alter the dosage as necessary.

Specific Considerations:

• Pregnancy: Sulfonamide ophthalmic formulations have not been used in animal reproductive experiments. Treatment with oral Sulfonamides throughout a pregnant woman's term pregnancy may result in kernicterus in the offspring. Pregnant women have not been the subject of sufficient, well-controlled trials on Sulfonamide ophthalmic preparations, and it is unknown if Sulfonamides used topically might affect the developing fetus. Only in cases where the possible benefits outweigh the possible risks to the developing fetus should this product be used during pregnancy.

• Nursing and Breastfeeding: Sulfonamides given systematically have the potential to cause kernicterus in newborns of nursing mothers. Given the risk of kernicterus in newborns, the mother's need for the medication should be considered while deciding whether to stop breastfeeding or to stop the medication altogether.

• Use in Pediatrics: It is unknown if these products are safe or effective for use with infants younger than two months old.