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JAMA. 1948;138(14):1054. doi:10.1001/jama.1948.02900140046020.
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To the Editor:—  Our experience with combined sulfonamide therapy leads us to believe that Drs. Garb and Janoff, in their letter of October 2, underestimated the advantages of this method of administering sulfonamide compounds. During the past three years we have compared a sulfadiazine-sulfamerazine combination and several triple sulfonamide combinations with sulfadiazine alone with or without sodium bicarbonate. A definite reduction in the frequency with which sulfonamide crystals were encountered in urine occurred when the double combination replaced sulfadiazine. When triple combinations were used, crystals of sulfonamide drug were seldom encountered. Administered in this form, the triple combinations were as effective as sodium bicarbonate used in amounts sufficient (12 to 24 Gm. daily) to raise the pH of urine to 7.1 or higher. In earlier studies pH 7.1 was found to represent the critical pH of urine above which sulfonamide crystals seldom occurred. Administration of sodium bicarbonate


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