rifampin


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rifampin

 [rif-am´pin]
a semisynthetic derivative of rifamycin, with the antibacterial actions and uses of the rifamycin group; administered orally or intravenously.

rifampin (rifampicin (UK))

Rifadin, Rofact (CA)

Pharmacologic class: Rifamycin derivative

Therapeutic class: Antitubercular

Pregnancy risk category C

Action

Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms (mycobacteria and some gram-positive and gram-negative bacteria)

Availability

Capsules: 150 mg, 300 mg

Powder for injection: 600 mg/vial

Indications and dosages

Tuberculosis

Adults: 10 mg/kg/day (up to 600 mg/day) P.O. or I.V. infusion as a single dose

Children: 10 to 20 mg/kg/day (up to 600 mg/day) P.O. or I.V. infusion as a single dose

Asymptomatic Neisseria meningitidis carriers

Adults: 600 mg P.O. or I.V. infusion b.i.d. for 2 days

Children ages 1 month and older: 10 mg/kg/day P.O. or I.V. infusion (up to 600 mg/day) q 12 hours for 2 days

Infants younger than 1 month old: 5 mg/kg P.O. or I.V. infusion q 12 hours for 2 days

Off-label uses

Mycobacterium avium intracellulare complex infection

• Brucellosis

Haemophilus influenzae type B

• Severe staphylococcal bone and joint infections

• Prosthetic valve endocarditis caused by coagulase-negative staphylococci

• Leprosy

• Prophylaxis in high-risk close contact of patients with N. meningitidis infections

Contraindications

• Hypersensitivity to drug or other rifamycin derivatives

Precautions

Use cautiously in:

• porphyria

• history of hepatic disease

• concurrent use of other hepatotoxic drugs

• pregnant or breastfeeding patients.

Administration

• Add 10 ml of sterile water to vial to yield a 60-mg/ml solution for I.V. infusion.

• Further dilute in 100 ml of dextrose 5% in water (D5W) and infuse over 30 minutes, or add to 500 ml of D5W and infuse over 3 hours.

• Give oral doses with a full glass of water 1 hour before or 2 hours after a meal.

• For an adult who can't swallow capsules or for a young child, mix capsule contents with syrup, shake well, and administer.

• If patient can't receive dextrose, use normal saline solution to dilute. Don't use other I.V. solutions.

Adverse reactions

CNS: ataxia, confusion, drowsiness, fatigue, headache, asthenia, psychosis, generalized numbness

EENT: conjunctivitis; discolored tears, saliva, and sputum

GI: nausea, vomiting, diarrhea, abdominal cramps, dyspepsia, epigastric distress, flatulence, discolored feces, anorexia, sore mouth and tongue, pseudomembranous colitis

GU: discolored urine

Hematologic: eosinophilia, transient leukopenia, hemolytic anemia, hemolysis, disseminated intravascular coagulation (DIC), thrombocytopenia

Hepatic: jaundice

Metabolic: hyperuricemia

Musculoskeletal: myalgia, joint pain

Respiratory: dyspnea, wheezing

Skin: flushing, rash, pruritus, discolored sweat, erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome

Other: flulike symptoms, hypersensitivity reactions including vasculitis

Interactions

Drug-drug. Barbiturates, beta-adrenergic blockers, cardiac glycosides, clarithromycin, clofibrate, cyclosporine, dapsone, diazepam, doxycycline, fluoroquinolones (such as ciprofloxacin), haloperidol, levothyroxine, methadone, progestins, quinine, tacrolimus, theophylline, tricyclic antidepressants, zidovudine: increased metabolism of these drugs Chloramphenicol, corticosteroids, disopyramide, efavirenz, estrogens, fluconazole, hormonal contraceptives, itra-conazole, ketoconazole, nevirapine, quinidine, opioid analgesics, oral hypoglycemics, phenytoin, quinidine, ritonavir, theophylline, tocainide, verapamil, warfarin: decreased efficacy of these drugs Delavirdine, indinavir, nelfinavir, saquinavir: decreased blood levels of these drugs

Hepatotoxic drugs (including isoniazid, ketoconazole, pyrazinamide): increased risk of hepatotoxicity

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, uric acid: increased levels

Dexamethasone suppression test: interference with results

Direct Coombs' test: false-positive result

Folate, vitamin B12 assay: interference with standard assays

Hemoglobin: decreased value

Liver function tests: abnormal values (transient)

Sulfobromophthalein uptake and excretion test: delayed hepatic uptake and excretion

Drug-behaviors. Alcohol use: increased risk of hepatotoxicity

Patient monitoring

• Monitor kidney and liver function tests, CBC, and uric acid level.

Watch for signs and symptoms of bleeding tendency, especially DIC.

• Assess for signs and symptoms of hepatic impairment.

• Monitor bowel movements for diarrhea, which may signal pseudomembranous colitis.

Patient teaching

• Advise patient to take oral dose 1 hour before or 2 hours after meals. If drug causes significant GI upset, instruct him to take it with meals. To further minimize GI upset, teach him to eat small, frequent servings of food and drink plenty of fluids.

Instruct patient to immediately report easy bruising or bleeding, fever, malaise, appetite loss, nausea, vomiting, or yellowing of skin or eyes.

• Tell patient drug may color his tears, urine, and other body fluids reddish or brownish orange. Instruct him not to wear contact lenses during therapy, because drug may stain them permanently.

• Instruct patient not to drink alcohol.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

rifampin

(rĭ-făm′pĭn) also

rifampicin

(-pĭ-sĭn)
n.
A semisynthetic antibiotic, C43H58N4O12, that is derived from a form of rifamycin and interferes with bacterial RNA synthesis, used to treat tuberculosis and other bacterial infections. Also called rifampicin.

rifampin

Tuberculosis An anti-TB drug used in Pts with a positive skin test who have been exposed to INH-resistant TB Adverse effects Hepatitis, adverse drug interactions, gastritis. See AIDS. Cf Rifalazil.
References in periodicals archive ?
Exclusion criteria were as follows: participants with a history of hepatitis B and C or other uncontrollable medical illness; pregnancy; history of allergy to isoniazid, rifampin, and pyrazinamide; history of an acute infectious disease 4 weeks before treatment; and liver function test results higher than the upper limit of normal.
The trial of the participants found that each five mg/kg per day increase in rifampin increased the elimination rate of TB bacteria from sputum.
Performance of the genotype MTBDR line probe assay for detection of resistance to rifampin and isoniazid in strains of Mycobacterium tuberculosis with low- and high-level resistance.
The goal of the statistical analysis plan was to describe the variability in measures of immune activation and intestinal function assays and to explore the relationship between immune activation, intestinal function, and rifampin pharmacokinetic parameters.
The recurrence of elevated transaminases one week post discharge is attributed to rifampin hepatotoxicity.
A trial demonstrated that patients randomized to three months of rifampin and isoniazid were 2.5 times more likely to complete treatment than those prescribed six months of isoniazid [17].
Self, "Update on rifampin, rifabutin, and rifapentine drug interactions," Current Medical Research and Opinion, vol.
(2) In vitro studies have demonstrated resistance of Brucella to rifampin. (16,17) In Egypt, Abdel-Maksoud et al.
Notably, LTBI treatment completion rates among health care workers rose by 26% between 2013, when most prescriptions were for rifampin or INH monotherapy, and 2014, when most were for rifapentine plus INH.
The 4 quadrants include one agar quadrant without antimicrobial agents to detect mycobacterial growth, a second containing agar with isoniazid, a third containing agar with rifampin, and a fourth containing agar with ciprofloxacin.
In the study, the company will randomly test 50 prosthetic joint infection patients with either oral CEM-102 along with rifampin or current standard-of-care antibiotics including vancomycin, nafcillin or cefazolin.
In 1982 the WHO (1) advocated multidrug therapy (MDT) for all forms of leprosy combining three drugs, dapsone, clofazimine, and rifampin; the last drug being the only one bactericidal for Mycobacterium leprae in clinical trials.