Sulfonamide antimicrobials (sulfonylarylamines)

	G6PD risk*	Description
Systemic agents^¶
Sulfadiazine	Low	As single agent or in combination with pyrimethamine
Sulfadoxine		As single agent or in combination with pyrimethamine; long-acting^◊
Sulfaguanidine^Δ	Low	Gastrointestinal antimicrobial
Sulfamerazine^Δ	Low	In combination with other sulfonamides or trimethoprim
Sulfamethizole^Δ		Urinary tract antimicrobial
Sulfamethazine (sulfadimidine)^Δ	High	As single agent or in combination with other sulfonamides
Sulfamethoxazole	Variable	In combination with trimethoprim or as single agent
Sulfametopyrazine^Δ		In combination with pyrimethamine; long-acting^◊
Sulfamoxole^Δ		In combination with trimethoprim
Sulfapyridine^Δ		Rarely used due to crystalluria risk
Sulfasalazine (salazosulfapyridine, salazopyrin)	High	Rheumatologic/gastrointestinal agent (nonantimicrobial); releases sulfapyridine in contact with gut flora
Sulfisoxazole (sulfafurazole)	High	As single agent or in combination with erythromycin
Topical and ophthalmic agents
Mafenide		Topical solution or cream
Silver sulfadiazine	Low	Topical cream or ointment
Sulfacetamide	High	As single agent ophthalmic solution, ointment, various topicals, vaginal or in combination with sulfabenzamide, sulfathiazole, or prednisolone
Sulfanilamide	High	As single agent vaginal or in combination with other antimicrobials

G6PD: glucose-6-phosphate dehydrogenase.
* Risk in G6PD deficiency may vary by type. See: www.g6pd.org/.
¶ The human immunodeficiency virus (HIV) protease inhibitors darunavir, fosamprenavir, and tipranavir, as well as the hepatitis C virus (HCV) protease inhibitor simeprevir contain sulfonamide moieties but lack one or both essential functional groups implicated in sulfonamide antibiotic hypersensitivity (ie, N4 arylamine or N-containing ring substitution at N1) and do not appear to cross-react. Refer to text.
Δ Not available commercially in United States.
◊ Long-acting sulfonamides may be more frequently implicated in allergic reactions and are cleared slowly upon discontinuation.

Graphic 82011 Version 7.0

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Sulfonamide antimicrobials (sulfonylarylamines)