A patient is being treated with sulfasalazine. The most likely purpose for giving it is for which of the following? (AIIMS May 2011)
|A||Antibiotic-associated pseudomembranous colitis|
|B||E. coli – induced diarrhea|
|C||Gastric H. pylori infections|
|D||Inflammatory bowel disease|
a. Sulfasalazine, which is a combination of sulfapyridine and 5-aminosalicylic acid (5-ASA) linked covalently (azo bond), is quite effective for managing inflammatory bowel disease (e.g., ulcerative colitis and Crohn’s disease).
b. Some of the sulfasalazine is absorbed, and a portion of that is excreted unchanged back into the colon. Colonic bacteria split the azo linkage, releasing the two drugs.
c. The 5-ASA is responsible for local anti-inflammatory activity (suppression of inflammatory mediators, but how, which, is not well understood) and symptom relief.
d. The other metabolite, sulfapyridine, is primarily responsible for side effects associated with this “two drugs in one” combination: nausea, vomiting, and headaches (dose-dependent); sulfonamide allergic reactions in “sulfa- sensitive” patients; and rare but potentially fatal blood reactions including immune-mediated hemolysis and aplastic anemia.