• FA is not formed and a number of essential metabolic reactions suffer

• Nausea, vomiting and epigastric pain
• Crystalluria
• Hypersensitivity , Steven Johnson syndrome
• Hepatitis
• Topical use- contact sensitization- so not allowed
• Hemolysis in person with G6PD deficient individuals
• Kernicterus precipitated in newborns

• Systemic use of sulfonamides alone is rare now
• Suppressive therapy of

chronic UTI

• Streptococcal pharyngitis
• As cotrimoxazole– P. jiroveci and nocardiosis
• Along with pyrimethamine- used for Malaria and Toxoplasmosis
• Ocular sulfacatamide- used in trachoma
• Topical sulfadiazine- in Burn

• All adverse effects seen with sulfonamides
• Nausea, vomiting, stomatitis, headache and rashes
• Folate deficiency- megaloblastic anemia
• Blood dyscarias
• Cotrimoxazole shouldn’t be given in pregnancy- neonatal haemolysis and methemoglobenemia
• Patient with renal disease- Uremia
• AIDS patient with P. jiroveci infection- Fever rash and BM supression
• BM toxicity in elderely

• UTI
• Respiratory tract infection- both URTI and LRTI, otitis media
• Bacterial diarrhea and dysentery- E.coli, Shigella, Salmonella, and Y. enterocolitica
• Pneumocystis jiroveci
• Chancroid
• Typhoid

• Active against gram negative bacteria- E. coli, Proteus, Klebsiella, Shigella but not Pseudomonas
• Inhibiting bacterial DNA gyrase and is bactericidal

• GI upset, rashes
• Neurological- headache, drowsiness, vertigo, visual disturbances, seizures
• Photoxicity
• G6PD deficiency- Hemolysis

• Urinary antiseptic
• Diarrhea- caused by Proteus, E.coli, Shigella or Salmonella

Prototype- Ciprofloxacin

• 1^st gen– More for gram negative
• 2^nd gen– also gram positive
• Inhibit enzyme bacterial DNA gyrase (primarily active in gram negative bacteria), which nicks double stranded DNA, introduces negative supercoils and the reseals the nicked ends
• Gram positive- target of FQ is Topoisomerase IV

• Good safety record
• GI– N, V, bad taste, anorexia, Diarrhea is rare
• CNS– dizziness, headache, restlessness, anxiety, insomnia, impairment of concentration
• Skin/hypersensitivity– rash, pruritus, photosensitivity, swelling of lips
• Tendinitis and tendon rupture

• UTI
• Gonorrhea
• Chancroid
• Bacterial enteritis
• Typhoid
• Bone, soft tissue, gynaecological and wound infections
• Respiratory infection
• TB– 2^nd line drug
• Gram negative septicaemia
• Meningitis– Gram negative
• Prophylaxis in neutropenic cancer
• Conjunctivitis