Sulfonamides: far from obsolete

Sulfa drugs or sulfonamides were introduced in 1935 by the German physician Gerhard Domagk (1895-1964). Domagk worked closely with two chemists, Fritz Mietzsch and Josef Klarer. They worked together on compounds related to synthetic dyes, testing their effects on infectious diseases. Their concerted work eventually led to the discovery of Prontosil (sulfamidochrysoidine), the first sulfa drug that showed an incredible antibacterial effect on diseased laboratory mice. Soon after the introduction of sulfonamides, penicillin was discovered and hailed as a more effective and a safer alternative. The production of sulfonamides lost its enthusiasm with the introductions of even more antibiotics. However; anti-bacterial Sulfonamides are far from being obsolete despite the introduction of newer classes of antibiotics. Interest in their use has been revived in the 1980s with AIDS epidemic, when a combination of sulfamethoxazole and trimethoprim (SMX/TMP) was recognized as the drug of choice for the treatment of Pneumocystis jirovecii (PCP) pneumonia. This review article is intended to update clinicians with the many still current recommendations for sulfonamides both as therapeutic and prophylactic agents; with mechanism of action and resistance; and with adverse side effects that clinicians need to watch for while using this class of antimicrobial.