Abstract
Cases of Stevens–Johnson syndrome have been increasingly reported in Nigeria by individuals who consumed meat products of animals especially goats injected sulfonamides. Hence, tissue distribution and residues of intramuscular sulfadimidine were studied in West African Dwarf (WAD) goats. Twenty goats divided into two groups of 10 each (five males; five females) weighing 10.4 ± 1.63 kg were administered intramuscular sulfadimidine (100 mg/kg body weight), and the second group was coadministered 5 mg/kg of piroxicam via right and left thigh muscle, respectively. Samples of the liver, kidney, spleen, heart, lung, intestine, brain, and skeletal muscle were collected into sterile cellophane bags. Two untreated goats were killed and used for preparation of tissue standards. The tissue samples were stored frozen for analysis. High concentration of sulfadimidine residues was found in all the tissues of goats administered sulfadimidine as well as tissues of goats coadministered sulfadimidine/piroxicam for up to 30 days postdrug administration. Generally, residues of sulfadimidine were observed to be significantly higher than the acceptable limit (0.1 ppm). Hence, consumption of meats from WAD goats administered sulfadimidine may pose very high risk of Stevens–Johnson syndrome in sensitive humans. As such consumption of such meats should be avoided.
Introduction
Piroxicam is used in ruminants to reduce pain, fever, and inflammation and in the treatment of different clinical conditions such as rheumatoid disorders and mastitis. 1 –4 It binds to plasma proteins, has a half-life of 50 h, and is excreted in urine and faeces. 5 The therapeutic effects are evident early in the treatment, and the response increases over several weeks. 6
Sulfadimidine has proven to be clinically useful since its introduction in both human and veterinary medicine as therapeutic agent for a wide range of microbial diseases, including Chlamydiosis, toxoplasmosis and coccidiosis. 7 –10 Several investigations in other species of ruminants such as cow, buffaloes, sheep, calves, and goat have shown that the dosage regimen of a drug should be determined clinically in the animal species. 11,12 Sulfadimidine is 79% bound to plasma proteins with a half-life of 3.88–15.4 h and has a particularly large percentage (60–90%) excretion as acetylated derivatives. 13
Quality and safety of food from animal products are of widely growing concern among public and health agencies around the world because of accumulation of drug residues. 14 A residue means any compound present in edible tissues that result from the use of a drug. 15 European Union reported that 51–52% noncompliant results of residues in animals were antibacterial drugs. 16 The maximum residue limit and minimum residue limit (MRL) of sulfonamides is 0.1 µg/g. 14 Hence, the “withdrawal period” which is defined as the time taken for the level of residues in the tissues to be depleted below the MRLs after the last dose must be determined. 17
Residue levels are correlated with the rates of tissue clearance, which in turn are related to the drug’s physicochemical properties and routes of metabolism and excretion. 18 Drug residues can accumulate in any tissue but are found commonly in liver, being an organ of metabolism and then kidney which is the main organ of excretion. 19
Small ruminates, particularly goats, play an important role in the economic life of small holder farmers converting low-cost inputs to high-valued products: meat, milk, and skin. 20 The money realized from sale of goats is used for the purchase of crop and inputs such as fertilizer and to meet compelling family financial obligations. 21,22 Owing to the common use of West African Dwarf (WAD) goats, the effect of piroxicam on the tissue kinetics of sulfadimidine was studied.
Piroxicam has a plasma protein binding capacity of 91% compared to sulfadimidine (79%). Simultaneous administration of the two drugs could lead to toxicity, prolonged stay of the drug in the body, and also interferes with the therapeutic efficacy of the drug with the lesser affinity. The use of sulfadimidine in food-producing animals has potential to generate residues in edible tissues, and piroxicam might increase the residence time. This could lead to Stevens–Johnson syndrome in humans.
There is a paucity of information on the effects of piroxicam on the tissue kinetics and distribution of sulfadimidine in WAD goats. This study intends to provide a rationale for adjustment in dosage regimen of intramuscular sulfadimidine when coadministered with piroxicam. The study is designed to demonstrate the basis for withdrawal period of intramuscular sulfadimidine when coadministered with piroxicam. The study will determine the intramuscular use of piroxicam and sulfadimidine in WAD goats and may also establish possible drug–drug interaction between sulfadimidine and piroxicam.
Materials and methods
Drugs and dosage
Sulfadimidine sodium (33.3 mg/ml) produced by Kepro, Holland, was used for the study at a single dose of 100 mg/kg body weight. Piroxicam (0.5%) produced by Hanbet, Shandong, China, was used for the study at a single dose of 5 mg/kg body weight.
Human equivalent dose (HED) formula was used to determine therapeutic dose of (5 mg/kg) piroxicam in WAD goats.
23,24
But human BSA = H
0.528 × W
0.528 × K.
Goat BSA = BW0.67 × 10−3.
Experimental animals
This study was conducted in the Department of Veterinary Physiology, Pharmacology and Biochemistry laboratory, College of Veterinary Medicine, University of Agriculture Makurdi. A sample size of five goats was used.
Twenty goats of both sexes aged 1 year weighing 10.4 ± 1.63 kg were used for this study. They were randomly selected and assigned into two groups of 10 each. The goats were fed corn offal and fresh grass, clean water was provided ad libitum. The animals were housed at the Veterinary Teaching Hospital of the University of Agriculture, Makurdi, during the period of study. All the animals were handled according to international standard for biomedical research involving animals as approved by Ethical Committee of the Department of Veterinary Physiology, Pharmacology and Biochemistry, University of Agriculture, Makurdi, Nigeria. 25
Administration and sampling of sulfadimidine
Five male and five female goats were administered intramuscular sulfadimidine (100 mg/kg body weight), and the second group of five male and five female goats was intramuscularly coadministered 100 mg/kg of sulfadimidine and 5 mg/kg of piroxicam, respectively, via right and left thigh muscle, respectively.
One goat from each group was killed on days 6, 12, 18, 24, and 30 post administration of sulfadimidine.
Samples of the liver, kidney, spleen, heart, lung, intestine, brain, abdominal fat, and skeletal muscle were collected into sterile cellophane bags and sample bottles. Two untreated goats were killed and used for preparation of tissue standards. The tissue samples were stored frozen until analyzed.
Assay of tissue sulfadimidine
For the analysis of sulfadimidine in tissues, 0.2 g of each tissue sample was crushed into fine particles and mixed with 3.80 ml of distilled water and treated with 1 ml of 20% trichloroacetic acid. After thorough mixing, the samples were allowed to stand for 10 min. They were centrifuged at 3000 rpm for 10 min. To 2 ml of clear supernatant, 0.1 ml of 0.1% sodium nitrate was added and mixed. The mixtures were allowed to stand for 3 min followed by addition of 0.2 ml 0.5% ammonium sulfamate and mixed. The samples were allowed to stand for 2 min before adding 0.2 ml 0.5% N-(1-naphthyl) ethylenediamine dihydrochloride. The samples were mixed, and the optical density of the resulting color determined at 540 nm wavelength using a spectrophotometer (spectrum lab 23A, 340–1000 nm). 26,27 The limit of detection of the assay was 0.05 µg/ml. The linear calibration curve of sulfadimidine in the tissues, within the range of 1–5 µg/ml, was obtained by plotting percentage absorbance against drug concentration. The correlation coefficient (R 2) was between 0.90 and 0.93 for all the tissues sampled.
Calculation of sulfadimidine concentration in tissue
The concentration of sulfadimidine in tissue was calculated using the following formula
Calculation of pharmacokinetic parameters of sulfadimidine in tissues
Tissue elimination half-life (T 1/2β) and elimination rate constant (β) were calculated using established equations. 28
Statistical analysis
Tissue concentrations, half-life, and elimination rate constant of goats administered sulfadimidine alone and sulfadimidine coadministered with piroxicam were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest for individual comparisons. The significance level was set at p < 0.05.
Results
The distribution of sulfadimidine in the tissues of WAD goats administered sulfadimidine alone was not significantly different (p > 0.05) from the tissues of goats administered sulfadimidine/piroxicam (Tables 1 to 9).
Concentration of sulfadimidine residues (ppm) in liver of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
Concentration of sulfadimidine residues (ppm) in kidney of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
Concentration of sulfadimidine residues (ppm) in spleen of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
Concentration of sulfadimidine residues (ppm) in heart of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05) within and between the groups.
Concentration of sulfadimidine residues (ppm) in lungs of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05) within and between the groups.
Concentration of sulfadimidine residues (ppm) in intestine of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
Concentration of sulfadimidine residues (ppm) in brain tissues of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
Concentration of sulfadimidine residues (ppm) in skeletal muscle tissues of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
Concentration of sulfadimidine residues (ppm) in fatty tissues of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
The elimination half-life and elimination rate constant of sulfadimidine were not significantly different (p > 0.05) between the tissues of WAD goats administered sulfadimidine alone and sulfadimidine/piroxicam (Tables 10 and 11).
Elimination half-life (h) of intramuscular sulfadimidine in the various tissues of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
Elimination rate constants (h−1) of intramuscular sulfadimidine in the various tissues of West African Dwarf goats administered sulfadimidine alone and sulfadimidine/piroxicam.a
aData were presented as mean ± standard error of mean and analyzed by two-way analysis of variance using GraphPad Prism 5.03 for windows followed by Bonferroni posttest. p > 0.05 within and between the groups.
Discussion
The presence of sulfadimidine residues on the sixth day postadministration in liver, kidney, skeletal muscle, spleen, lung, and heart of WAD goats shows that sulfadimidine can be absorbed when injected intramuscularly and distributed and resides in tissues in significant quantity in this species of animal. The absorption rate of sulfadimidine is affected by its solubility. 29 The increased level of sulfadimidine residues on days 3–30 in all the tissues of goats sampled showed that the administration of sulfadimidine at 100 mg/kg body weight alone or in combination with piroxicam (5 mg/kg) cannot be eliminated from WAD goats within 30 days. It has been reported that sulfadimidine is not easily excreted in some species of animals. 30 The highest level of residue was observed in the liver of goats administered sulfadimidine/piroxicam on day 6 (9.75 ± 0.34 ppm) and intestine on day 18 (9.91 ± 1.80 ppm), indicating that piroxicam can cause high accumulation of sulfadimidine residues in the liver and intestine of WAD goats and that sulfadimidine reside much more in the liver (the main organ of drug metabolism) and intestine than in the rest organs. This may be due to desamino-sulfonamide that has also been identified as residues of the parent drug 31 and may prefer liver to other organ, since liver is the main organ of drug metabolism. The desamino-metabolite is thought to be formed by bacteria in the gut following oral administration of the drug. Although sulfadimidine was administered via muscle, it occurred in high quantity in the intestine, signifying that even after intramuscular administration, it undergoes enterohepatic circulation, so that it can be metabolized by enteric bacteria. Desamino-sulfonamide is less polar, it is cleared more slowly, and this possibly explains why it is present at high concentration in the tissues thereby increasing withdrawal time. 32 Very high concentration of sulfadimidine in the affected tissue mostly liver and kidney may pose high risk of toxicity to the organs. Sulfadimidine is nephrotoxic. 33 The presence of residues (>0.1 ppm) of sulfadimidine in all the affected tissues of the sulfadimidine and sulfadimidine/piroxicam injected WAD goats on day 30 may pose a risk of Stevens–Johnson syndrome to consumers. The concentration of sulfadimidine residues in tissues reported in this work is unlikely to be nephrotoxic to consumers. Our findings disagree with the report that sulfadimidine is an intermediate acting sulfonamide that last for 12–24 h in the body. 34 Sulfadimidine residues (0.1–0.4 ppm) in the kidney, liver, and spleen of turkeys after 3 days of withdrawal and as long as 14 days and 35 in hen, 0.01–0.47 ppm of sulfadimidine residue have been reported. 36 Therefore, variation of withdrawal time of sulfadimidine has been reported as 3 days for broilers, 37 5–6 days for skeletal muscle and 7 days for liver of fattening chickens, 38 and 4 days for tissues in hen. 39
Very high tissue levels of sulfadimidne recorded in the present study (>0.2 ppm) poses high risk to consumers. In Australia, the minimum residue limit (MRL) of sulfonamide in turkey is 0.2 ppm. 40 In the Europe, the MRL of sulfonamide in most edible tissues is 0.1 ppm. 14 But the tissue residue of sulfadimidine in liver, kidney, skeletal muscle, heart, and brain of rabbit were undetectable after 12 days of administration in rabbit. 14 In pig, the tissue residue of sulfadimidine was depleted to <0.1 ppm in 4 days and 8–10 days in liver and kidney, respectively. 41 In sheep, sulfadimidine residue was detected at the level <0.14 ppm after 3.5 days. 42 In the present study, the half-life of sulfadimidine residues in the affected organs is 470.35–1700.79 h. This is at variance with the report indicating that the tissue half-life was between 5.63 and 16.31 h. 43 This may be due to the difference in the route of administration. However, the most obvious reason for unacceptable residues might be due to the failure to keep the withdrawal period including using overdose and long-acting drugs. 44 Lack of difference in the half-life and elimination rate constant between residue of sulfadimidine in sulfadimidine and sulfadimidine/piroxicam injected WAD goats shows that piroxicam does not affect half-life and elimination rate constant of tissue residue of sulfadimidine in the goats. But our present finding is at variance with the report indicating that rabbit has higher elimination rate constant (0.010–0.23 h) 43 in comparison with turkeys 0.002–0.001 h 45 and WAD goats (0.00058–0.00149 h) signifying difference in the route of administration, mode of metabolism, drug interaction, and elimination. Higher elimination half-life of sulfadimidine in WAD goats may also pose risk of environmental contamination, most especially, when droppings from goats administered sulfadimidine are used as organic manure. Sulfadimidine concentration of ground water was 0.6 ng/L. 46 Sulfadimidine in manure and soil may affect soil microbial and enzyme activities. 47 For example, it was found to have significant effects on soil respiration with an effective concentration (EC10) of 13 mg/kg in the first 2 days of an experimental test. 48 Sulfonamides affect both the functioning (i.e., enzymatic activities) and the structural diversity of a soil microbial community at relatively low antibiotic concentration, 1–900 µg/g, 49 signifying that sulfonamides are a persistent organic pollutant due to its resistance to biological decomposition and it is regularly detected in surface waters even up to 1 µg/dm 3 levels because of their widespread human and veterinary application. 50
Conclusion
Since piroxicam competes with sulfadimidine for same binding site (albumin), piroxicam must have delayed the elimination of sulfadimidine from the kidney, spleen, lung, intestine, and brain of WAD goats. Tissue residues exceeded recommended maximum residue limit (>1 ppm). Hence, piroxicam could aggravate Stevens–Johnson syndrome in sensitive individuals who consume the meat of WAD goats administered sulfadimidine and piroxicam concurrently.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
