Sulfacetamide sodium is used topically for the treatment of conjunctivitis and other superficial infections of the eye caused by susceptible bacteria.
Sulfacetamide sodium has also been used topically as an adjunct to oral sulfonamide therapy for the treatment of trachoma. The most widely used therapy for trachoma is topical treatment with erythromycin, tetracycline (no longer commercially available in the US), or sulfacetamide ointment, or oral erythromycin or a tetracycline. Oral azithromycin also is effective. Systemic anti-infective therapy (e.g., oral erythromycin, azithromycin, doxycycline) is used for the treatment of chlamydial conjunctivitis; data to support use of topical anti-infectives, in conjunction with systemic therapy, are not available.
Sulfacetamide sodium is used in combination with corticosteroids for the treatment of corticosteroid-responsive ocular conditions when a corticosteroid is indicated and bacterial infection or risk of infection exists. Concomitant topical corticosteroids may mask the clinical signs of bacterial, fungal, or viral infections and prevent recognition of ineffectiveness of sulfacetamide; suppression of hypersensitivity reactions to substances in the product and/or increased intraocular pressure may also occur. However, in one controlled study, the treatment of blepharitis with a combination of sulfacetamide and a corticosteroid resulted in a reduced healing time as compared to the use of sulfacetamide alone; some patients who received only sulfacetamide required subsequent steroid therapy for the management of continued and severe inflammation.
For systemic uses of sulfonamides, see Sulfonamides 8:12.20.
Dosage and Administration
Sulfacetamide sodium is applied topically to the eye as an ophthalmic ointment, solution, or suspension containing 10% of the drug.
When the 10% ointment is used for the treatment of conjunctivitis and other superficial infections, a ribbon of the ointment (approximately 1.25 cm in length) may be applied in the conjunctival sac every 3-4 hours and at bedtime. Alternatively, the ointment may be applied at night in conjunction with the daytime use of the ophthalmic solution. When the 10% solution is used for this indication, initially 1 or 2 drops may be instilled into the lower conjunctival sac every 2-3 hours, dosing may be reduced gradually. Usual duration of therapy is 7-10 days.
When the 10% fixed-combination suspension containing fluorometholone is used, 1 drop may be instilled into the lower conjunctival sac 4 time daily. Dosing may be reduced, but therapy should not be discontinued prematurely. If signs and symptoms fail to improve after 2 days, the patient should be reevaluated. In chronic conditions, therapy should be withdrawn gradually by decreasing the application frequency. The suspension should be shaken well before using.
For the treatment of trachoma, 2 drops of the 10% solution may be instilled every 2 hours in conjunction with systemic sulfonamide therapy; alternatively, a small amount of sulfacetamide sodium ophthalmic ointment may be applied to each eye twice daily for 2 months or twice daily for the first 5 days of each month for 6 months.
Topical application of sulfonamides may produce sensitization and preclude later systemic use of these drugs. In addition, patients who have been sensitized by systemic sulfonamide administration may exhibit hypersensitivity reactions following topical application of the drugs. Stevens-Johnson syndrome occurred following use of sulfacetamide sodium ophthalmic ointment in one patient who had a history of bullous lesions with systemic sulfonamide therapy. In addition, a case of local hypersensitivity that progressed to a fatal syndrome resembling systemic lupus erythematosus has occurred.
The most frequently reported adverse effects following topical application of sulfacetamide sodium ophthalmic preparations are local irritation, stinging, and burning. Conjunctivitis, conjunctival hyperemia, and secondary infections have been reported less frequently.
Precautions and Contraindications
The possibility of adverse reactions associated with systemic use of sulfonamides should be considered in patients receiving topical sulfonamides. If hypersensitivity reactions occur during sulfonamide therapy, the drug should be discontinued immediately. Sulfonamides are contraindicated in patients who have previously exhibited hypersensitivity to sulfonamides or other ingredients in the formulations.
The use of sulfonamides may result in the overgrowth of nonsusceptible organisms including fungi. The manufacturers also caution that sulfonamides are inactivated by purulent exudates. (See Mechanism of Action.)
Although some ophthalmic ointment vehicles used in the past were reported to retard corneal wound healing, currently used ophthalmic ointment vehicles do not appear to slow the rate of corneal wound healing; in addition, ointments may provide a protective effect if the cornea is exposed. However, the manufacturers caution that ophthalmic ointments have retarded corneal healing.
When combination products containing sulfacetamide sodium are used, the precautions applicable to all ingredients should be observed.
Topical application of sulfacetamide sodium is not recommended by the manufacturers in infants younger than 2 months of age.
Sulfonamides should not be used with preparations containing silver. (See Chemistry and Stability: Stability).
Because of reported in vitro antagonism, sulfacetamide sodium should not be used concomitantly with gentamicin sulfate.
Sulfonamides do not appear to be appreciably absorbed from mucous membranes.