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Rifampin

Pronunciation

Class: Antituberculosis Agents
VA Class: AM500
CAS Number: 13292-46-1
Brands: Rifadin, Rimactane, Rifamate, Rifater

Introduction

Antibacterial and antimycobacterial agent; semisynthetic derivative of rifamycin SV.161

Uses for Rifampin

Tuberculosis

Treatment of active (clinical) tuberculosis (TB) in conjunction with other antituberculosis agents.176 203 258 r v IV rifampin is designated an orphan drug by FDA for this use.178

First-line agent for treatment of all forms of active TB caused by Mycobacterium tuberculosis known or presumed to be susceptible to the drug.176 258 r v Essential component of multiple-drug regimens used in the initial intensive treatment phase and the continuation treatment phase.176 258 r v

Fixed-combination preparation containing rifampin and isoniazid (Rifamate) is used for treatment of pulmonary TB.258 259 Isoniazid and rifampin are both used in the initial intensive treatment phase and the continuation treatment phase,258 but manufacturer states that Rifamate is not recommended for initial therapy and the fixed-combination preparation should be used only after the patient has been treated with the individual components and efficacy of these drugs has been established.259

Fixed-combination preparation containing rifampin, isoniazid, and pyrazinamide (Rifater) is used for treatment of pulmonary TB;172 258 designated an orphan drug by FDA for this use.178 Used only in the initial intensive treatment phase since pyrazinamide is not usually indicated for the continuation phase.172 258

For initial treatment of active TB caused by drug-susceptible M. tuberculosis, recommended multiple-drug regimens consist of an initial intensive phase (2 months) and a continuation phase (4 or 7 months).176 258 Although the usual duration of treatment for drug-susceptible pulmonary and extrapulmonary TB (except disseminated infections and TB meningitis) is 6–9 months,176 258 ATS, CDC, and IDSA state that completion of treatment is determined more accurately by the total number of doses and should not be based solely on the duration of therapy.258 A longer duration of treatment (e.g., 12–24 months) usually is necessary for infections caused by drug-resistant M. tuberculosis.176 258

Patients with treatment failure or drug-resistant M. tuberculosis, including multidrug-resistant (MDR) TB (resistant to both isoniazid and rifampin) or extensively drug-resistant (XDR) TB (resistant to both isoniazid and rifampin and also resistant to a fluoroquinolone and at least one parenteral second-line antimycobacterial such as capreomycin, kanamycin, or amikacin), should be referred to or managed in consultation with experts in the treatment of TB as identified by local or state health departments or CDC.258 x

Latent Tuberculosis Infection

Treatment of latent tuberculosis infection (LTBI).176 177 194 215 225 269 t u v

LTBI is asymptomatic infection with M. tuberculosis; usually defined as a positive tuberculin skin test (TST) or Quantiferon-TB gold test (QFT-G) with no evidence of active (clinical) TB.176 194 215 225 269 u v LTBI is treated to decrease the risk of progression to active TB.194 215 t u

Regimen of choice for treatment of LTBI is isoniazid monotherapy, unless the patient has been in contact with an individual with drug-resistant TB.176 177 194 215 225 269 t v Rifampin monotherapy is the preferred alternative and is especially useful in adults, adolescents, or children who have been exposed to isoniazid-resistant M. tuberculosis and those who cannot tolerate isoniazid.176 177 194 215 269 Rifabutin is used in those who cannot receive rifampin because of intolerance or because they are receiving other drugs that have clinically important interactions with rifampin (e.g., HIV patients receiving certain antiretroviral agents).101 177 194 215 225 269 v

Although 2-drug regimens of rifampin and pyrazinamide were previously used for treatment of LTBI,176 177 194 215 t v these regimens have been associated with an increased risk of hepatotoxicity and are no longer recommended for treatment of LTBI.257 269 t v (See Hepatic Effects under Cautions.)

Treatment of LTBI in patients who have been exposed to a source case with drug-resistant TB, including MDR TB or XDR TB, should be managed in consultation with experts in the treatment of TB as identified by local or state health departments or CDC.176 215 269 t u v

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Prior to initiating treatment of LTBI, clinical (active) TB must be excluded using appropriate testing (e.g., radiographs).176 177 194 215 225 269 t v

Anthrax

Has been used in conjunction with other anti-infectives for treatment of inhalational anthrax following bioterrorism-related anthrax exposures.252 253

Multiple-drug parenteral regimens are recommended for treatment of inhalational anthrax that occurs as the result of exposure to Bacillus anthracis spores in the context of biologic warfare or bioterrorism.139 252 254 Initiate treatment with IV ciprofloxacin or doxycycline and 1 or 2 other anti-infectives predicted to be effective (e.g., chloramphenicol, clindamycin, rifampin, vancomycin, clarithromycin, imipenem, penicillin, ampicillin);252 253 254 if meningitis is established or suspected, use IV ciprofloxacin (rather than doxycycline) and chloramphenicol, rifampin, or penicillin.254

Bartonella Infections

Treatment of infections caused by Bartonella henselae (e.g., cat scratch disease, bacillary angiomatosis, peliosis hepatitis).176 203 233 234 235

Cat scratch disease generally self-limited in immunocompetent individuals and may resolve in 2–4 months; some clinicians suggest that anti-infective therapy be considered for acutely or severely ill patients with systemic manifestations, particularly those with hepatosplenomegaly or painful lymphadenopathy, and such therapy probably is indicated in immunocompromised patients. 176 233 236 237 238 Anti-infectives also indicated in patients with B. henselae infections who develop bacillary angiomatosis, neuroretinitis, or Parinaud's oculoglandular syndrome.236 237 238 Optimum regimens have not been identified; some clinicians recommend erythromycin, azithromycin, doxycycline, ciprofloxacin, rifampin, co-trimoxazole, or gentamicin.176 203 236 237 238

Brucellosis

Treatment of brucellosis caused by Brucella melitensis.176 203 227 228 229 230 270 Used as an adjunct to other anti-infectives.176 203 227 228 229 230 270 Tetracyclines generally considered the drugs of choice; concomitant use of another anti-infective (e.g., streptomycin or gentamicin and/or rifampin) is recommended to reduce the likelihood of relapse, especially for severe infections and when there are complications such as meningitis, endocarditis, or osteomyelitis.176 203 227 228 229 230 270 Also has been used as an adjunct to co-trimoxazole or quinolones (ciprofloxacin, ofloxacin).176 203 227 228 229 230 270 Monotherapy is not recommended.176 270

Postexposure prophylaxis following a high-risk exposure to Brucella (e.g., percutaneous or mucous membrane exposure or aerosolization of infectious material in the laboratory or livestock husbandry setting, exposure in the context of biologic warfare or bioterrorism).139 176 Postexposure prophylaxis not generally recommended after exposure to endemic brucellosis.139 176 Regimens recommended for postexposure prophylaxis are the same as those recommended for treatment of brucellosis.139

Ehrlichiosis and Anaplasmosis

Alternative for treatment of human granulocytotropic anaplasmosis (HGA; formerly human granulocytic ehrlichiosis) caused by Anaplasma phagocytophilum (formerly Ehrlichia phagocytophila).203 241 k Doxycycline is usual drug of choice for anaplasmosis;176 203 241 k rifampin can be used for mild illness due to HGA in those who cannot receive doxycycline (e.g., children <8 years of age, pregnant women).k

Rifampin is ineffective for treatment of Lyme disease; patients receiving rifampin for treatment of HGA who are coinfected with B. burgdorferi should receive amoxicillin or cefuroxime for treatment of Lyme disease.k

Legionella Infections

Treatment of infections caused by Legionella pneumophila (Legionnaires’ disease); used as an adjunct to a macrolide (e.g., azithromycin, erythromycin), a fluoroquinolone (e.g., ciprofloxacin, ofloxacin, levofloxacin), or a tetracycline (e.g., doxycycline).146 166 176 203 226 232

Leprosy

Treatment of leprosy in conjunction with other anti-infectives.176 198 199 203 205 206 207 jj

WHO and others recommend rifampin-based multiple-drug regimens (ROM) for treatment of all forms of leprosy, including multibacillary leprosy (>5 skin lesions), paucibacillary leprosy (2–5 lesions), and single-lesion paucibacillary leprosy (single skin lesion with definite loss of sensation but without nerve trunk involvement).176 198 199 201 202 203 204 205 206 207 jj

Because rifampin is bactericidal against M. leprae, it is the principal component of multiple-drug regimens used for treatment of leprosy;198 199 200 201 207 jj other drugs are included in the regimens to prevent emergence of rifampin-resistant M. leprae.198 199 206 207 jj

Treatment of leprosy is complicated and should be undertaken in consultation with a specialist familiar with the disease (e.g., clinicians at the National Hansen's Disease Program at 800-642-2477 or ).176 kk

Mycobacterium avium Complex (MAC) Infections

Treatment of M. avium complex (MAC) pulmonary infections in conjunction with other antimycobacterials.176 191

For initial treatment of nodular/bronchiectatic pulmonary disease caused by macrolide-susceptible MAC, ATS and IDSA recommend a 3-times weekly regimen of clarithromycin (or azithromycin), ethambutol, and rifampin in most patients.191 For initial treatment of fibrocavitary or severe nodular/bronchiectatic pulmonary disease caused by macrolide-susceptible MAC, ATS and IDSA recommend a daily regimen of clarithromycin (or azithromycin), ethambutol, and rifampin (or rifabutin) and state that consideration can be given to adding amikacin or streptomycin during the first 2–3 months of treatment for extensive (especially fibrocavitary) disease or when previous therapy has failed.191

Although either rifampin or rifabutin can be used in multiple-drug regimens for treatment of MAC infections, rifampin may be the preferred rifamycin for most patients with pulmonary MAC infections since it may be better tolerated (e.g., in older patients).191 Rifabutin may be the preferred rifamycin for treatment of disseminated MAC disease (especially in HIV-infected patients) since it appears to be more active in vitro against MAC and is associated with fewer drug interactions.176 191 r s Rifampin is not included in current ATS, CDC, NIH, and IDSA guidelines for treatment of disseminated MAC infections in HIV-infected individuals.191 r s

Treatment of MAC infections is complicated and should be directed by clinicians familiar with mycobacterial diseases; consultation with a specialist is particularly important when the patient cannot tolerate first-line drugs or when the infection has not responded to prior therapy or is caused by macrolide-resistant MAC.191 In addition, specialized references should be consulted for guidance on the use of rifamycins in HIV-infected patients receiving antiretroviral agents.191 (See Specific Drugs and Tests under Interactions.)

Mycobacterium kansasii and Other Mycobacterial Infections

Treatment of M. kansasii infections in conjunction with other antimycobacterials.176 191 203 ATS and IDSA recommend a regimen of isoniazid, rifampin, and ethambutol for treatment of pulmonary or disseminated infections caused by rifampin-susceptible M. kansasii.191 If rifampin-resistant M. kansasii are involved, ATS and IDSA recommend a 3-drug regimen based on results of in vitro susceptibility testing, including clarithromycin (or azithromycin), moxifloxacin, ethambutol, sulfamethoxazole, or streptomycin.191

Treatment of M. marinum infections in conjunction with other antimycobacterials (e.g., ethambutol with or without clarithromycin).176 191 203 bb cc ff Optimum regimens not identified.191 bb cc ff Monotherapy (minocycline, clarithromycin, doxycycline, co-trimoxazole) may be effective for superficial cutaneous infections,bb but a multiple-drug regimen usually used for severe cutaneous infections or infections in immunocompromised individuals.bb cc

Treatment of M. ulcerans infections with or without other antimycobacterials.176 191 ATS and IDSA state that preulcerative lesions can be effectively treated by excision and primary closure, rifampin monotherapy, or heat therapy.191 Surgical debridement with skin grafting usually is the treatment of choice for M. ulcerans infections since antimycobacterials generally are ineffective.191 However, postsurgical antimycobacterials may prevent relapse or metastasis of infections and a regimen of clarithromycin and rifampin is recommended to control complications of M. ulcerans ulcers.191

Treatment of infections caused by M. xenopi in conjunction with other antimycobacterials.191 Optimum regimens not established; in vivo response may not correlate with in vitro susceptibility.191 ATS and IDSA state that a regimen of clarithromycin, rifampin, and ethambutol generally has been used, although rate of relapse is high.191 A regimen of isoniazid, rifampin (or rifabutin), ethambutol, and clarithromycin (with or without streptomycin during initial treatment) also has been suggested.191

Neisseria meningitidis Infections

Prophylaxis to prevent meningococcal disease in household or other close contacts of individuals with invasive meningococcal disease when the risk of infection is high.176 179 187 266 Recommended regimens for such prophylaxis are rifampin (not recommended in pregnant women), ceftriaxone, or ciprofloxacin (not recommended in individuals <18 years of age unless no other regimen can be used and not recommended for pregnant or lactating women).176 187 AAP considers rifampin the drug of choice in most pediatric patients.176

Elimination of nasopharyngeal carriage of Neisseria meningitidis.161 163 176 179 187 266 CDC and AAP recommend rifampin, ceftriaxone, or ciprofloxacin for such carriers.176 179 187 Manufacturers state rifampin should not be used indiscriminately and should be used only when the risk of meningococcal meningitis is high.161 163 176 179

Should not be used for treatment of meningococcal infections; rapid emergence of resistant strains may occur during long-term therapy.161 163 266

Rhodococcus Infections

Treatment of infections caused by Rhodococcus equi; used in conjunction with vancomycin.203 Optimum regimens have not been identified; combination regimens usually are recommended, including vancomycin given with a fluoroquinolone, rifampin, a carbapenem (imipenem or meropenem), or amikacin.203 239 240

Staphylococcal and Streptococcal Infections

Treatment of serious infections (bacteremia, pneumonia, and meningitis) caused by penicillin-resistant Streptococcus pneumoniae or oxacillin-resistant Staphylococcus aureus or S. epidermidis (previously known as methicillin-resistant S. aureus or S. epidermidis) in conjunction with other anti-infectives (e.g., third generation cephalosporins, vancomycin).176 203 226 Rifampin should not be used alone in the treatment of staphylococcal or streptococcal infections.176 203

Prevention of Haemophilus influenzae Type b Infection

Chemoprophylaxis in contacts of patients with Haemophilus influenzae type b (Hib) infection.102 103 104 105 106 134 135 138 140 141 176 Considered the most effective anti-infective for eradicating carriage of Hib.102 103 104 105 106 134 138 141 AAP and ACIP state rifampin is the drug of choice for chemoprophylaxis in contacts of patients with Hib infection.134 135 141 145 176

In household contacts of patients with Hib infection, AAP recommends prophylaxis for all household contacts (except pregnant women), irrespective of age, in those households with at least one contact <48 months of age who is incompletely vaccinated against Hib, those households with an immunocompromised child (even if the child is >48 months of age), and those households where there is a child <12 months of age, irrespective of the vaccination status of the child.176

In child-care and nursery school contacts of patients with Hib infection, AAP recommends prophylaxis for all attendees (regardless of age) if ≥2 cases of invasive disease have occurred within 60 days and there are unvaccinated or incompletely vaccinated children attending the facility.176 If a single case has occurred, the advisability of rifampin prophylaxis in exposed child-care groups with unimmunized or incompletely immunized children is controversial, but many experts recommend no prophylaxis.176

Rifampin Dosage and Administration

Administration

Administer orally.161 May be given by IV infusion if oral therapy is not feasible.161 b Should not be given IM or sub-Q.161 b

Used in conjunction with other anti-infectives for treatment of active (clinical) TB, anthrax, brucellosis, legionella infections, leprosy, MAC or other mycobacterial infections, rhodococcus infections, and staphylococcal and streptococcal infections.127 146 176 161 166 176 191 198 200 203 204 206 207 226 227 229 230 232 258

Fixed-combination preparations (Rifamate containing rifampin and isoniazid; Rifater containing rifampin, isoniazid, and pyrazinamide) can be used for treatment of active TB infection to reduce the pill burden and ensure compliance, especially when directly observed (supervised) therapy (DOT) cannot be used.258 A fixed-combination preparation should be used only when all drugs in the preparation are indicated.258

Oral Administration

Administer single-entity rifampin or fixed-combination preparations (Rifamate , Rifater) orally with a full glass of water 1 hour before or 2 hours after a meal.161 172 259

For individuals who are unable to swallow rifampin capsules and when lower doses are needed for children, a 1% suspension can be prepared using Syrup NF (simple syrup), Syrpalta syrup (Emerson Laboratories), or Raspberry syrup (HumCo Laboratories).161 To prepare a suspension containing rifampin 10 mg/mL, empty the contents of four 300-mg or eight 150-mg capsules and mix the contents vigorously with 20 mL of a recommended syrup; then further dilute with 100 mL of the syrup.161 Shake well prior to administration.161

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by IV infusion.161 b

Avoid extravasation.161 b Discontinue infusion and restart at another site if local irritation and inflammation occur at the site of infusion.161 b

Reconstitution and Dilution

Reconstitute vial containing 600 mg of rifampin powder by adding 10 mL sterile water for injection and gently swirling the vial.161 b Reconstituted solution contains 60 mg/mL.161 b

Prior to administration, add the appropriate dose of reconstituted solution to 100 or 500 mL of 5% dextrose injection or 0.9% sodium chloride injection.161 b

Rate of Administration

If infusion volume is 100 mL, give IV at a rate that allows complete infusion within 30 minutes.161 b

If infusion volume is 500 mL, give IV at a rate that allows complete infusion within 3 hours.161 b

Dosage

Oral and IV dosages are the same.161

Dosage of Rifamate expressed as number of capsules;259 dosage of Rifater expressed as number of tablets.172

Pediatric Patients

General Dosage for Infants and Children
Oral or IV

Children ≥1 month of age: AAP recommends 10–20 mg/kg (up to 600 mg) daily given in 1 or 2 divided doses for mild to moderate infections or 20 mg/kg (up to 600 mg) daily in 2 divided doses for severe infections.176

Tuberculosis
Treatment of Active (Clinical) Tuberculosis
Oral

Children <15 years of age or weighing ≤40 kg: 10–20 mg/kg (up to 600 mg) daily recommended by manufacturer, ATS, CDC, IDSA, AAP, and others.161 176 258 s v If an intermittent regimen is used, 10–20 mg/kg (up to 600 mg) 2 or 3 times weekly.176 258 s v

Adolescents ≥15 years of age: 10 mg/kg (up to 600 mg) daily.258 v If an intermittent regimen is used, 10 mg/kg (up to 600 mg) 2 or 3 times weekly.258 v

Rifater in adolescents ≥15 years of age: 4 tablets once daily in those weighing ≤44 kg, 5 tablets once daily in those weighing 45–54 kg, or 6 tablets once daily in those weighing ≥55 kg.172 Used only in the initial phase of treatment.172

When used for the treatment of active TB in HIV-infected individuals with CD4+ T-cell counts <100/mm3, rifampin should be given at least 3 times weekly.101 r CDC and others recommend these patients receive a once-daily regimen during the initial intensive treatment phase and either a once-daily or 3-times weekly regimen during the continuation phase.100 r

IV

10–20 mg/kg (up to 600 mg) daily.161 b v

Latent Tuberculosis Infection (LTBI)
Oral

10–20 mg/kg (up to 600 mg) once daily for 4–6 months.176 177 194 215 269 v If daily regimen cannot be used, AAP states 10–20 mg/kg (up to 600 mg) twice weekly for 6 months can be administered using directly observed (supervised) therapy (DOT) .176

ATS and CDC recommend that completion of therapy for LTBI be based on total number of administered doses rather duration of therapy alone.194 215 When rifampin monotherapy is used, at least 120 doses should be administered within 6 months.215 Ideally, patients should receive the drug on a regular dosing schedule until completed; in practice, some doses may be missed requiring the course to be lengthened.215 If the regimen is resumed after an interruption of ≥2 months, a medical examination is indicated to rule out active TB.194 215

Brucellosis
Treatment or Prevention
Oral

15–20 mg/kg (up to 600–900 mg) daily; given in conjunction with other anti-infectives.176

For postexposure prophylaxis, continue for 3–6 weeks;139 for treatment, continue for 4–6 weeks (more prolonged therapy may be needed in serious infections or when there are complications).139 176

Ehrlichiosis and Anaplasmosis
Mild Anaplasmosis
Oral

10 mg/kg (up to 300 mg) twice daily for 7–10 days.k

Leprosy
Multibacillary Leprosy
Oral

Children <10 years of age: 300 mg once monthly in conjunction with dapsone (25 mg once daily) and clofazimine (50 mg twice weekly and 100 mg once monthly).204

Children 10–14 years of age: 450 mg once monthly in conjunction with dapsone (50 mg once daily) and clofazimine (50 mg every other day and 150 mg once monthly).204 jj

Usual duration of treatment is 12 months.198 200 206 207 jj An additional 12 months of treatment may be necessary in some patients (e.g., those with a high baseline bacterial index who have no evidence of improvement or have evidence of deterioration after the initial 12 months of treatment).jj

Paucibacillary Leprosy
Oral

Children <10 years of age: 300 mg once monthly in conjunction with dapsone (25 mg once daily).204

Children 10–14 years of age: 450 mg once monthly in conjunction with dapsone (50 mg once daily).204 jj

Usual duration of treatment is 6 months.204 jj

Single-lesion Paucibacillary Leprosy
Oral

Children 5–14 years of age: A single 300-mg dose of rifampin in conjunction with a single dose of ofloxacin (200 mg) and a single dose of minocycline (50 mg).204

Children <5 years of age: Use an appropriately adjusted dose of each drug in the above single-dose regimen.204

Neisseria meningitidis Infections
Prophylaxis in Household or Other Close Contacts
Oral

Neonates <1 month of age: 5 mg/kg every 12 hours for 2 days.176 179 187

Children ≥1 month of age: 10 mg/kg (up to 600 mg) every 12 hours for 2 days.176 179 187

Initiate as soon as possible after contact, preferably within 24 hours after identification of the index case.176 179 187

Elimination of Pharyngeal Carrier State
Oral

Neonates <1 month of age: 5 mg/kg every 12 hours for 2 days.161

Children ≥1 month of age: 10 mg/kg (up to 600 mg) every 12 hours for 2 days.161

Staphylococcal and Streptococcal Infections
Meningitis Caused by S. pneumoniae
IV

Children ≥1 month of age: 20 mg/kg daily given in divided doses every 12 hours; used as an adjunct to other anti-infectives (e.g., vancomycin).176

Prevention of Haemophilus influenzae Type b Infection
Oral

Neonates <1 month of age: Some clinicians recommend 10 mg/kg once daily for 4 consecutive days.134 176

Children ≥1 month of age: 20 mg/kg (up to 600 mg) once daily for 4 consecutive days.134 138 176

Adults

Tuberculosis
Treatment of Active (Clinical) Tuberculosis
Oral

10 mg/kg (up to 600 mg) once daily recommended by the manufacturers, ATS, CDC, IDSA, and others.161 258 r v If an intermittent regimen is used, 10 mg/kg (up to 600 mg daily) 2 or 3 times weekly.258 v

Rifamate: 2 capsules once daily.259

Rifater: 4 tablets once daily in adults weighing ≤44 kg, 5 tablets once daily in adults weighing 45–54 kg, or 6 tablets once daily in adults weighing ≥55 kg.172 Used only in the initial phase of treatment.172

When used for the treatment of active TB in HIV-infected individuals with CD4+ T-cell counts <100/mm3, rifampin should be given at least 3 times weekly.r CDC and others recommend these patients receive a once-daily regimen during the initial intensive phase and either a once-daily or 3-times weekly regimen during the continuation phase.100 r

IV

10 mg/kg (up to 600 mg) once daily.161

Latent Tuberculosis Infection (LTBI)
Oral

10 mg/kg (up to 600 mg) once daily for 4 months.177 194 215 v

ATS and CDC recommend that completion of therapy for LTBI be based on total number of administered doses rather duration of therapy alone.194 215 When rifampin monotherapy is used, at least 120 doses should be administered within 6 months.215 Ideally, patients should receive the drug on a regular dosing schedule until completed; in practice, some doses may be missed requiring the course to be lengthened.215 If the regimen is resumed after an interruption of ≥2 months, a medical examination is indicated to rule out active TB.194 215

Anthrax
Inhalational Anthrax
IV

300 mg every 12 hours has been used in conjunction with other anti-infectives.127

Anthrax Meningitis
IV

20 mg/kg daily in conjunction with other anti-infectives.139

Brucellosis
Oral

15–20 mg/kg (up to 600–900 mg) daily in conjunction with other anti-infectives.139 176 227 229 230 Some clinicians suggest 0.6–1.2 g daily in conjunction with other anti-infectives.270

For postexposure prophylaxis, continue for 3–6 weeks; 139 for treatment, continue for 4–6 weeks (more prolonged therapy may be needed in serious infections or when there are complications).139 176 Some clinicians state that 6–8 weeks of treatment may be necessary in patients with skeletal disease and ≥3 months (and possibly >6 months) of treatment may be necessary in those with meningoencephalitis or endocarditis.139

Ehrlichiosis and Anaplasmosis
Mild Anaplasmosis
Oral

300 mg twice daily for 7–10 days.k

Leprosy
Multibacillary Leprosy
Oral

600 mg once monthly in conjunction with dapsone (100 mg once daily) and clofazimine (50 mg once daily and 300 mg once monthly).198 200 204 206 207 jj

Usual duration of treatment is 12 months.198 200 206 207 jj An additional 12 months of treatment may be necessary in some patients (e.g., those with a high baseline bacterial index who have no evidence of improvement or have evidence of deterioration after the initial 12 months of treatment).jj

Paucibacillary Leprosy
Oral

600 mg once monthly in conjunction with dapsone (100 mg once daily).198 200 204 206 207 jj

Usual duration of treatment is 6 months.198 200 204 206 207 jj

Single-lesion Paucibacillary Leprosy
Oral

A single 600-mg dose of rifampin in conjunction with a single dose of ofloxacin (400 mg) and a single dose of minocycline (100 mg).204 jj

Mycobacterium avium Complex (MAC) Infections
Initial Treatment of Pulmonary MAC Infections (Nodular/bronchiectatic Disease) Caused by Macrolide-susceptible Strains
Oral

600 mg 3 times weekly in conjunction with ethambutol (25 mg/kg 3 times weekly) and either clarithromycin (1 g 3 times weekly) or azithromycin (500 mg 3 times weekly) recommended by ATS and IDSA.191 Continue until patient has been culture negative on treatment for 1 year.191

Intermittent (3-times weekly) regimen is not recommended for those with cavitary or moderate or severe disease or those who have been previously treated.191

Initial Treatment of Pulmonary MAC Infections (Fibrocavitary or Severe Nodular/bronchiectatic Disease) Caused by Macrolide-susceptible Strains
Oral

10 mg/kg (up to 600 mg) once daily in conjunction with ethambutol (15 mg/kg once daily) and either clarithromycin (0.5–1 g daily) or azithromycin (250 mg once daily) recommended by ATS and IDSA.191 Continue until patient has been culture negative on treatment for 1 year.191 Consideration can be given to including amikacin or streptomycin 3 times weekly during the first 2–3 months of treatment for extensive, especially fibrocavitary, disease or when previous therapy has failed.191

Mycobacterium kansasii and Other Mycobacterial Infections
Treatment of Pulmonary or Disseminated Infections Caused by Rifampin-susceptible M. kansasii
Oral

10 mg/kg (up to 600 mg) daily in conjunction with ethambutol (15 mg/kg once daily), isoniazid (5 mg/kg [up to 300 mg] daily), and pyridoxine (50 mg daily) recommended by ATS and IDSA.191

Continue until patient has been culture negative on treatment for 1 year.191 A longer duration may be needed in HIV-infected individuals with disseminated infections.191

Treatment of M. marinum Infections
Oral

600 mg dailybb ff in conjunction with ethambutol (15–25 mg/kg daily).bb ff

Optimal duration of treatment not known; continue for 3–6 months or until at least 1–2 months after resolution of symptoms.191 bb cc ff

Neisseria meningitidis Infections
Prophylaxis in Household or Other Close Contacts
Oral

600 mg every 12 hours for 2 days.187

Initiate as soon as possible after contact, preferably within 24 hours after identification of the index case.176 179 187

Elimination of Pharyngeal Carrier State
Oral or IV

600 mg twice daily for 2 days.161 b

Prevention of Haemophilus influenzae Type b Infection
Oral

20 mg/kg (up to 600 mg) once daily for 4 consecutive days.134 138 176

Prescribing Limits

Pediatric Patients

Tuberculosis
Active (Clinical) Tuberculosis
Oral or IV

Maximum 600 mg per dose in once-daily or 2- or 3-times weekly regimens.161 176 258 269 s v

Latent Tuberculosis Infection (LTBI)
Oral or IV

Maximum 600 mg per dose in once-daily or twice-weekly regimens.161 176 258 269 s v

Brucellosis
Oral

Maximum 600–900 mg daily.176

Ehrlichiosis and Anaplasmosis
Mild Anaplasmosis
Oral

Maximum 300 mg twice daily.176

Neisseria meningitidis Infections
Prophylaxis or Elimination of Pharyngeal Carrier State
Oral

Children ≥1 month of age: Maximum 600 mg every 12 hours.161

Prevention of Haemophilus influenzae Type b Infection
Oral

Maximum 600 mg once daily.134 138 176

Adults

Tuberculosis
Active (Clinical) Tuberculosis
Oral or IV

Maximum 600 mg per dose in once-daily or 2- or 3-times weekly regimens.161 215 258 v

Latent Tuberculosis Infection (LTBI)
Oral or IV

Maximum 600 mg once daily.161 215 258 v

Brucellosis
Oral

Maximum 600–900 mg daily.139 227 229 230

Mycobacterium avium Complex (MAC) Infections
Initial Treatment of Pulmonary MAC Infections (Fibrocavitary or Severe Nodular/bronchiectatic Disease) Caused by Macrolide-susceptible Strains
Oral

Maximum 600 mg once daily.139 227 229 230

Mycobacterium kansasii and Other Mycobacterial Infections
Treatment of Pulmonary or Disseminated Infections Caused by Rifampin-susceptible M. kansasii
Oral

Maximum 600 mg daily.139 227 229 230

Special Populations

Renal Impairment

Dosage adjustment not required in renal impairment or end-stage renal disease if dosage is ≤600 mg daily.161 258

Cautions for Rifampin

Contraindications

  • Known hypersensitivity to rifampin or other rifamycins (rifabutin, rifapentine).161

Warnings/Precautions

Warnings

Hepatic Effects

Hepatic dysfunction reported.161 Fatalities associated with jaundice reported in patients with preexisting liver disease or receiving other hepatotoxic agents.161 Discontinue if signs of hepatocellular damage occur.161 (See Hepatic Impairment under Cautions.)

Hyperbilirubinemia (resulting from competition between rifampin and bilirubin for excretory pathways in the liver) can occur shortly after initiation of rifampin therapy.161 An isolated report of a moderate increase in bilirubin and/or transaminase concentrations is not an indication to interrupt rifampin therapy; the decision to discontinue the drug should be made after repeating the tests, noting trends in the concentrations, and considering the patient’s clinical condition.161

Transient abnormalities in liver function tests (e.g., elevated serum bilirubin, alkaline phosphatase, serum transaminases) and reduced biliary excretion of contrast media used for visualization of the gallbladder reported; the gallbladder test should be performed prior to the morning dose of rifampin.161

Severe liver injuries, including some fatalities, have been reported in patients receiving a 2-drug regimen of pyrazinamide and rifampin (once daily for 2 months) for the treatment of LTBI.177 222 225 257 A 2-drug regimen of rifampin and pyrazinamide should be considered for treatment of LTBI only in carefully selected patients with close monitoring and only if potential benefits outweigh the risk of hepatotoxicity and death.257 If a rifampin and pyrazinamide regimen is used, monitor serum aminotransferases and bilirubin concentrations at baseline and at 2, 4, 6, and 8 weeks; assess patient at 2, 4, 6 and 8 weeks for adherence, tolerance, and adverse effects.257 Permanently discontinue in asymptomatic patients with an aminotransferase concentration >5 times the ULN, in patients with symptoms of hepatitis who have an aminotransferase concentration >ULN, and in patients who have serum bilirubin concentrations >ULN (regardless of the presence or absence of symptoms).257

Patients with Porphyria

There have been isolated reports of exacerbation of porphyria in patients receiving rifampin; rifampin has enzyme-inducing properties, including induction of delta amino levulinic acid synthetase.161

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity reactions characterized by flu-like syndrome with episodes of fever, chills, and sometimes with headache, dizziness, and bone pain reported.115 Edema of the face and extremities, decrease in blood pressure, shock, or dyspnea (sometimes accompanied by wheezing) also reported.115 161

Pruritus, urticaria, acneiform eruptions,154 155 rash, pemphigoid reactions, erythema multiforme including Stevens-Johnson syndrome,154 156 161 toxic epidermal necrolysis,161 vasculitis,161 eosinophilia, sore mouth, sore tongue,154 exfoliative dermatitis,153 and exudative conjunctivitis reported.a Anaphylaxis reported rarely.154 161

Some cutaneous reactions, including flushing and pruritus (with or without rash), are mild and self-limiting and do not appear to be hypersensitivity reactions.161 More serious cutaneous reactions occur less frequently and do appear to be hypersensitivity reactions.161

Sulfite Sensitivity

Rifampin sterile powder for injection contains sulfites, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.a

General Precautions

Endocrine Effects

Possible enhanced metabolism of endogenous substrates (e.g., cortisol, thyroid hormones, vitamin D) secondary to hepatic microsomal enzyme induction.108 161

Decreased plasma concentrations of 25-hydroxy vitamin D (the major circulating metabolite of vitamin D) and/or 1α,25-dihydroxy vitamin D accompanied by decreased plasma calcium and phosphate concentrations and increased parathyroid hormone concentrations reported.161 223 b

Discoloration of Body Fluids

Urine, sputum, sweat, or tears may have a reddish coloration.161 172 258 259 b Soft contact lenses may become permanently stained.161 172 258 b

Patient Monitoring

Obtain baseline measurements of liver function (hepatic enzymes, bilirubin) and hematologic status (CBC, platelet count) in adults receiving rifampin for treatment of TB; baseline tests not considered necessary in pediatric patients unless a complicating condition is known or suspected.161

Evaluate patient at least monthly during therapy; question patient about adverse effects.161 Follow up all abnormalities, including laboratory monitoring, if indicated.161 Routine laboratory monitoring for drug-induced toxicity generally not necessary in patients with normal baseline test results.161

Use of Fixed Combinations

When the fixed-combination preparations (Rifamate containing rifampin, isoniazid, and pyrazinamide or Rifater containing rifampin and isoniazid) are used, observe the usual precautions and contraindications associated with all drugs in the preparation.172 259 Use these preparations only when all drugs contained in the fixed combination are indicated.258

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of rifampin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.161

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.161 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.161

If used to eliminate nasopharyngeal carriage of N. meningitidis or for postexposure prophylaxis to prevent meningococcal disease, a short-term rifampin regimen (e.g., 2-day regimen) should be used since resistant strains of N. meningitidis may rapidly emerge during prolonged rifampin treatment.161 Rifampin should be used only when the risk of meningococcal disease is high.161 Appropriate diagnostic laboratory procedures (e.g., serotyping, in vitro susceptibility testing) should be performed.161

Precautions Related to Treatment of Tuberculosis

When used for treatment of TB, there is some evidence that rifampin dosage >600 mg once daily or twice weekly is associated with a higher incidence of adverse reactions, including flu syndrome (fever, chills, malaise), hematopoietic reactions (leukopenia, thrombocytopenia, acute hemolytic anemia), cutaneous, GI, and hepatic reactions, shortness of breath, shock, anaphylaxis, and renal failure.161 Regimens using rifampin 600 mg twice weekly (in conjunction with isoniazid 15 mg/kg) are better tolerated.161

Should not be used alone for the treatment of active TB; must be used in conjunction with other antituberculosis agents.258

Clinical specimens for microscopic examination and mycobacterial cultures and in vitro susceptibility testing should be obtained prior to initiation of antituberculosis therapy and periodically during treatment to monitor therapeutic response.258 The antituberculosis regimen should be modified as needed.258 Patients with positive cultures after 4 months of treatment should be considered to have failed treatment (usually as the result of noncompliance or drug-resistant TB).258

Compliance with the full course of antituberculosis therapy and all drugs included in the multiple-drug regimen is critical.258 Missed doses increase the risk of treatment failure and increase the risk that M. tuberculosis will develop resistance to the antituberculosis regimen.258

To ensure compliance, ATS, CDC, IDSA, and AAP recommend that directly observed (supervised) therapy (DOT) be used for treatment of active (clinical) TB and for treatment of LTBI whenever possible, especially when intermittent regimens are used, when the patient is immunocompromised or infected with HIV, or when drug-resistant M. tuberculosis is involved.176 215 269 r s u v

When used for the treatment of active (clinical) TB in HIV-infected individuals with CD4+ T-cell counts <100/mm3, once- or twice-weekly rifampin regimens are associated with an increased risk of emergence of resistant M. tuberculosis.r CDC and others recommend these patients receive once-daily or 3-times weekly rifampin regimens.100 r

Specific Populations

Pregnancy

Category C.161

A regimen of isoniazid, rifampin, and ethambutol is recommended by ATS, CDC, IDSA, and AAP for treatment of active TB in pregnant women.176 258 r

Rifampin administration during the last few weeks of pregnancy can cause postnatal hemorrhages in the mother and infant; treat such hemorrhages with vitamin K.161 Some experts recommend prophylactic administration of vitamin K (10 mg) to neonates born to women who received rifampin during pregnancy.r

Lactation

Distributed into milk.176 Discontinue nursing or the drug.161

Pediatric Use

Used in pediatric patients for the treatment of active (clinical) TB and treatment of LTBI,167 169 171 176 to eliminate nasopharyngeal carriage of N. meningitidis,161 163 176 179 187 for chemoprophylaxis against meningococcal disease176 179 187 or H. influenzae type b (Hib) infection,102 103 104 134 135 136 137 138 144 145 176 and for treatment of leprosy.198 204 206

Rifater: Safety and efficacy not established in children <15 years of age; the ratio of rifampin and isoniazid in this preparation may not be appropriate for this age group.172

Rifamate: Safety and efficacy not established in pediatric patients.259

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.161 Clinical experience has not identified differences in response relative to younger adults.161

Use caution.161

Hepatic Impairment

Use in patients with impaired liver function only when clearly necessary and only under strict medical supervision; fatalities associated with jaundice reported in patients with liver disease.161

Monitor liver function (ALT and AST) before initiating therapy and every 2–4 weeks during therapy in patients with impaired hepatic function.161 Discontinue if signs of hepatocellular damage occur.161

Exacerbation of porphyria reported.161

Common Adverse Effects

GI effects (heartburn, epigastric distress, nausea, vomiting, anorexia, abdominal cramps, flatulence, diarrhea).161 a

Interactions for Rifampin

Induces certain CYP enzymes.161

Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes

Pharmacokinetic interactions likely with drugs metabolized by CYP enzymes; increased metabolism of these drugs.161

Specific Drugs and Tests

Drug or Test

Interaction

Comments

β-Adrenergic blocking agents

Potential increased metabolism of the β-adrenergic blocking agent161

Dosage adjustment of the β-adrenergic blocking agent may be needed161

Aminosalicylic acid

Decreased rifampin serum concentrations reported with certain aminosalicylic acid preparations;aa not reported with commercially available aminosalicylic acid delayed-release granules (Paser)aa

May be caused by an excipient not included in commercially available aminosalicylic acid delayed-release granules (Paser)aa

Antacids

Possible decreased absorption of rifampin161

Administer rifampin at least 1 hour before antacids161

Antiarrhythmic agents (disopyramide, mexiletine, quinidine, tocainide)

Potential increased metabolism of the antiarrhythmic agent110 111 161

Dosage adjustment of the antiarrhythmic agent may be needed161

Anticoagulants, oral

Potential increased metabolism of warfarin and decreased anticoagulant effect161

Monitor PT daily or as frequently as necessary to establish and maintain required anticoagulant dosage161

Anticonvulsants (phenytoin)

Potential increased phenytoin metabolism161

Dosage adjustment of phenytoin may be needed161

Antifungals, azole (fluconazole, itraconazole, ketoconazole, voriconazole)

Decreased plasma concentrations of fluconazole, itraconazole, ketoconazole, or voriconazole;131 132 161 242 262 264 265 o altered rifampin concentrations161 264 265

Antifungal efficacy may be decreased263 264

Itraconazole or ketoconazole: Concomitant use not recommended131 132 242 264 265

Fluconazole: If used with rifampin, fluconazole dosage may needed to be increased161 262

Voriconazole: Concomitant use contraindicatedo

Antifungals, echinocandins (anidulafungin, caspofungin, micafungin)

Caspofungin: Decreased caspofungin trough concentrations; no effect on rifampin concentrationsm q

Anidulafungin or micafungin: No evidence of pharmacokinetic interactionn p

Caspofungin: Increase caspofungin dosage to 70 mg dailym q

Anidulafungin or micafungin: Dosage adjustment not necessaryn p

Antiretrovirals, entry inhibitors

Decreased AUC and concentrations of maraviroc101 ee

Dosage adjustment necessary;101 ee if used with rifampin, use maraviroc dosage of 600 mg twice daily101 ee

Some experts state concomitant use with rifampin not recommended and suggest use of rifabutin as an alternative101

Antiretrovirals, HIV fusion inhibitors

Enfuvirtide: Pharmacokinetic interaction unlikely272

Antiretrovirals, HIV integrase inhibitors

Decreased raltegravir concentrations101

Clinical importance unclear; use with caution or consider alternative101

Antiretrovirals, HIV protease inhibitors (PIs)

Decreased concentrations of atazanavir, fosamprenavir, indinavir, lopinavir, nelfinavir, ritonavir, or saquinavir101 124 126 152 175 177 192 256 260 j

Possible decreased darunavir concentrations; possible decreased antiretroviral activity101

Possible decreased tipranavir concentrations; possible decreased antiretroviral activity and increased risk of tipranavir resistancec

Concomitant use with atazanavir, ritonavir-boosted darunavir, fosamprenavir, indinavir, ritonavir-boosted indinavir, fixed combination of lopinavir and ritonavir, nelfinavir, ritonavir, ritonavir-boosted saquinavir, or ritonavir-boosted tipranavir not recommended101 126 260 c j

Antiretrovirals, nonnucleoside reverse transcriptase inhibitors (NNRTIs)

Delavirdine, efavirenz, or nevirapine: Decreased plasma concentrations of the NNRTI101 217 218

Nevirapine: Potential for additive hepatotoxicity; virologic consequences uncertain101

Delavirdine: Concomitant use contraindicated101

Efavirenz: If used with rifampin, use efavirenz 600 mg once daily in patients weighing <50 kg or consider using efavirenz 800 mg once daily101

Nevirapine: Concomitant use not recommended; if used concomitantly, monitor carefully101

Antiretrovirals, nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs)

Zidovudine: Decreased plasma concentrations of the NRTI251

Tenofovir: Pharmacokinetic interaction unlikely271

Tenofovir: Dosage adjustments not necessary271

Atovaquone

Decreased atovaquone concentrations and half-life;161 261 gg increased rifampin concentrations161

Concomitant use not recommended261 gg

Barbiturates

Potential increased metabolism of the barbiturate161

Dosage adjustment of the barbiturate may be needed161

Benzodiazepines (diazepam)

Potential increased metabolism of diazepam161

Dosage adjustment of diazepam may be needed161

Calcium-channel blocking agents (diltiazem, nifedipine, verapamil)

Potential increased metabolism of the calcium-channel blocking agent161

Decreased plasma verapamil concentrations; loss of therapeutic effect of oral verapamil reported157 158 159 160

Dosage adjustment of the calcium-channel blocking agent may be needed161

Cardiac glycosides

Potential increased metabolism of the cardiac glycoside161

Dosage adjustment of the cardiac glycoside may be needed161

Chloramphenicol

Potential increased metabolism of chloramphenicol121 161

Dosage adjustment of chloramphenicol may be needed161

Clofazimine

Clinically important interaction unlikely in leprosy patients142 143

Clofibrate

Potential increased metabolism of clofibrate161

Dosage adjustment of clofibrate may be needed161

Co-trimoxazole

Increased rifampin concentrations161

Corticosteroids

Potential increased metabolism of the corticosteroid 109 161

Dosage adjustment of the corticosteroid may be needed161

Dapsone

Potential increased metabolism and decreased plasma concentrations of dapsone 161 gg

Dosage adjustment of dapsone may be needed161

Dosage of dapsone used in multiple-drug regimens (rifampin with or without clofazimine) for treatment of leprosy is well established;198 200 204 206 207 change in dapsone dosage in these regimens not requiredgg

Doxycycline

Potential increased metabolism of doxycycline 161

Dosage adjustment of doxycycline may be needed161

Enalapril

Decreased concentrations of enalaprilat, the active metabolite161

Adjust enalapril dosage as required161

Erlotinib

Possible decreased erlotinib AUCf

Avoid concomitant use if possiblef

If alternative to rifampin cannot be used, consider increasing erlotinib dosage (as tolerated at 2-week intervals) during rifampin therapy and decreasing erlotinib dosage to usual dosage when rifampin is discontinued; closely monitor patientf

Fluoroquinolones (ciprofloxacin)

Potential increased metabolism of ciprofloxacin;161 possible increased rifampin concentrations193

Lupus-like syndrome reported in a few patients receiving rifampin and ciprofloxacin193

Dosage adjustment of ciprofloxacin may be required161

Halothane

Increased risk of hepatotoxicity161

Concomitant use not recommended161

Hormonal contraceptives

Potential increased metabolism of the estrogen and/or progestin161

Use nonhormonal methods of contraception161

Immunosuppressive agents (cyclosporine, tacrolimus)

Decreased concentrations of the immunosuppressive agent161 243 244 245 246 246

Monitor concentrations of the immunosuppressive agent; adjust dosage of the immunosuppressive agent accordingly243 244 245 246

Isoniazid

Increased risk of hepatotoxicity161

Monitor closely for signs and symptoms of hepatotoxicity161

Levothyroxine

Potential increased levothyroxine metabolism161

Dosage adjustment of levothyroxine may be needed161

Macrolides (clarithromycin)

Potential increased metabolism of clarithromycin;161 possible increased rifampin concentrations193

Lupus-like syndrome reported in a few patients receiving rifampin and clarithromycin193

Dosage adjustment of clarithromycin may be needed161

Opiate agonists (methadone)

Potential increased metabolism of the opiate agonist161

Dosage adjustment of the opiate agonist may be needed161

Probenecid

Increased rifampin concentrations161

Psychotherapeutic agents (amitriptyline, haloperidol, nortriptyline)

Potential increased metabolism of the psychotherapeutic agent161

Dosage adjustment of the psychotherapeutic agent may be needed161

Pyrazinamide

Severe liver injuries, including some fatalities, reported in patients receiving a 2-month daily regimen of rifampin and pyrazinamide for treatment of LTBI222 225

Use of rifampin and pyrazinamide for treatment of LTBI should be considered only in carefully selected patients with close monitoring and only if potential benefits outweigh the risk of hepatotoxicity and death257

Quinine

Possible decreased plasma concentrations of quinine161

Dosage adjustment of quinine may be needed161

Rosiglitazone

Decreased rosiglitazone AUCi

Dosage adjustment of rosiglitazone may be neededi

Sulfasalazine

Possible decreased plasma concentrations of sulfapyridine161

Sulfonylurea antidiabetic agents

Potential increased metabolism of the sulfonylurea agent; diabetes may be more difficult to control161

Dosage adjustment of the antidiabetic agent may be needed161

Telithromycin

Decreased telithromycin concentrations and AUCh

Avoid concomitant useh

Tests for opiates

Possible cross-reactivity and false-positive results in opiate urine screening tests that use kinetic interaction of microparticles in solution (KIMS) method161 or opiate immunoassaysii

Perform confirmatory tests (e.g., gas chromatography/mass spectrometry)161 ii

Tests for serum folate and vitamin B12

Standard microbiologic assays for serum folate and vitamin B12 are inhibited by therapeutic rifampin concentrations161

Consider using alternative assays to determine serum folate and vitamin B12161

Theophylline

Potential increased metabolism of theophylline161

Dosage adjustment of theophylline may be needed161

Tinidazole

Possible decreased tinidazole concentrationsg

Rifampin Pharmacokinetics

Absorption

Bioavailability

Well absorbed from GI tract;161 peak plasma concentrations achieved within 1–4 hours following oral administration.161 a

Food

Absorption reduced 30% when administered with food.122 161

Special Populations

Plasma concentrations of rifampin are higher and more prolonged in patients with impaired hepatic function, especially in the presence of obstructive jaundice.a

Distribution

Extent

Distributed into most body tissues and fluids including the liver, lungs, bile, pleural fluid, prostate, seminal fluid, ascitic fluid, CSF, saliva, tears, and bone.a 161

CSF concentrations in patients with inflamed meninges reported to be 10–20% of concurrent plasma concentrations.258 a

Rifampin crosses the placenta and is distributed into cord blood.161

Distributed into milk.a

Plasma Protein Binding

80–91%.161 a

Elimination

Metabolism

Metabolized in the liver to a deacetylated derivative which possesses antibacterial activity.161 a Rifampin undergoes enterohepatic circulation161 and is largely reabsorbed, but the metabolite is not.a

Elimination Route

60% of an oral dose is excreted in feces via biliary elimination;a 30% is excreted in urine as unchanged drug and active metabolite.161 a

Not removed by hemodialysis or peritoneal dialysis.a

Half-life

Adults: 3.35 hours after a single 600-mg dose or 5.08 hours after a single 900-mg dose.161 Following repeated doses in adults, half-life averages 2–3 hours.161

Children 6 months to 4.8 years of age receiving a 10-mg/kg oral dose: 2.9 hours.161

Children 3 months to 12.8 years of age receiving 300 mg/m2 by IV infusion over 30 minutes: Half-life ranges from 1.04–3.81 hours early in therapy and 1.17–3.19 hours after 5–14 days of therapy.161

Special Populations

Dosage ≤600 mg daily in patients with renal failure: Half-life similar to that in those with normal renal function.161

Single 900-mg oral dose in patients with renal impairment: Half-life increased compared with values reported in those with normal renal function.161 Mean plasma half-life increased from 3.6 hours in healthy adults to 5, 7.3, or 11 hours in those with GFR of 30–50 mL/minute, those with GFR <30 mL/minute, or in anuric patients, respectively.161

Stability

Storage

Oral

Capsules

Avoid excessive heat; store in a dry place in tightly closed container.161

Rifamate: Avoid excessive heat; store in a dry place in tightly closed container.259

Tablets

Rifater: 15–30°C.172 Protect from excessive humidity.172

Suspension

Extemporaneously prepared suspension containing 10 mg/mL (see Oral Administration under Dosage and Administration): Room temperature (25°C) or 2–8°C for up to 4 weeks.161

Parenteral

Powder for Injection

15–30°C.b Avoid temperatures >40°C; protect from light.161 b

Solutions reconstituted with sterile water for injection (60 mg/mL) are stable at room temperature for 24 hours.161 Solutions that have been further diluted with 5% dextrose injection are stable at room temperature for up to 4 hours; these solutions should be used within 3–4 hours.161 HID

Manufacturer states that reconstituted solutions that have been further diluted with 0.9% sodium chloride are stable at room temperature for up to 24 hours;161 other information indicates substantial rifampin decomposition occurs in 24 hours; these solutions should be used within 3–4 hours.HID

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Incompatible

Dextrose 5% in watera

Sodium chloride 0.9%a

a Incompatible by conventional definition; recommended for dilution with use for shorter periods of time.

Drug CompatibilityHID
Y-Site Compatibility

Incompatible

Diltiazem HCl

Actions and Spectrum

  • A rifamycin structurally and pharmacologically similar to other rifamycins (rifabutin, rifapentine).

  • Usually bactericidal.161

  • Suppresses initiation of chain formation for RNA synthesis in susceptible bacteria by inhibiting DNA-dependent RNA polymerase.161 a

  • Spectrum of activity includes some gram-positive and -negative bacteria and some Mycobacterium.161

  • Mycobacterium: Active in vitro against M. tuberculosis,a M. bovis,a M. marinum,a dd M. kansasii,a and some strains of M. fortuituma and M. avium complex.a Also active against M. leprae.a

  • Gram-positive bacteria: Active against S. aureus, S. epidermidis, and Bacillus anthracis.161 252

  • Gram-negative bacteria: Active against N. meningitidis,161 H. influenzae, Brucella melitensis, and L. pneumophila.161 230 241 Also active against Ehrlichia canis, E. chaffeensis, and Anaplasma phagocytophilum.l

  • Natural and acquired resistance to rifampin observed in vitro and in vivo in M. tuberculosis, M. kansasii,165 and N. meningitidis.189 190 Strains of M. leprae resistant to rifampin reported rarely.128 133 jj β-lactamase production has no effect on rifampin activity.161

  • Cross-resistance occurs between rifampin and other rifamycin derivatives (rifabutin, rifapentine).161 258 a M. tuberculosis resistant to rifampin usually are resistant to both rifabutin and rifapentine; only rarely are rifampin-resistant strains susceptible to rifabutin.258

  • M. tuberculosis resistant to both isoniazid and rifampin (MDR TB) occurs.w x y z There also have been recent reports of extensively drug-resistant (XDR) TB in various parts of the world, including the US.w x z XDR TB is caused by M. tuberculosis resistant to rifampin and isoniazid (multiple-drug resistant strains) that also are resistant to a fluoroquinolone and at least one parenteral second-line antimycobacterial (capreomycin, kanamycin, amikacin).w x z

Advice to Patients

  • Advise patients that antibacterials (including rifampin) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).161

  • Importance of completing full course of therapy, even if feeling better after a few days.161

  • Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with rifampin or other antibacterials in the future.161

  • Advise patients that poor compliance with antituberculosis regimens can result in treatment failure and development of drug-resistant TB, which can be life-threatening and lead to other serious health risks.258

  • Importance of taking rifampin 1 hour before or 2 hours after a meal with a full glass of water.161

  • Advise patient that rifampin may impart a reddish color to urine, feces, sweat, sputum, and tears.161 172 258 259 b Soft contact lenses may become permanently stained.161 172 258 b

  • Importance of informing clinicians if fever, loss of appetite, malaise, nausea, vomiting, darkened urine, yellow discoloration of the skin or eyes, or pain or swelling of the joints occurs.161

  • Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs, as well as any concomitant illnesses.161

  • Advise women that reliability of systemic hormonal contraceptives may be affected; alternative contraceptives should be considered.161 172

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.161

  • Importance of informing patients of other important precautionary information.161 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Rifampin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

150 mg*

Rifadin

Sanofi-Aventis

Rifampin Capsules

Sandoz, VersaPharm

300 mg*

Rifadin

Sanofi-Aventis

Rifampin Capsules

Sandoz, VersaPharm

Rimactane (with parabens)

Actavis

Parenteral

For injection

600 mg*

Rifadin IV (with sodium formaldehyde sulfoxylate)

Sanofi-Aventis

Rifampin for Injection (with sodium formaldehyde sulfoxylate)

Bedford

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Rifampin Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

300 mg with Isoniazid 150 mg*

Rifamate

Sanofi-Aventis

Rifampin and Isoniazid Capsules

VersaPharm

Tablets

120 mg with Isoniazid 50 mg and Pyrazinamide 300 mg

Rifater (with povidone and propylene glycol)

Sanofi-Aventis

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Rifadin 150MG Capsules (SANOFI-AVENTIS U.S.): 60/$166.32 or 180/$475.20

Rifamate 150-300MG Capsules (SANOFI-AVENTIS U.S.): 60/$265.67 or 180/$777.53

Rifampin 150MG Capsules (SANDOZ): 60/$115.99 or 180/$309.96

Rifampin 300MG Capsules (LANNETT): 30/$64.99 or 90/$175.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions February 1, 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Centers for Disease Control and Prevention. Notice to readers: acquired rifamycin resistance in persons with advanced HIV disease being treated for active tuberculosis with intermittent rifamycin-based regimens. MMWR Morb Mortal Wkly Rep. 2002; 51:214-5. [IDIS 486051] [PubMed 11922192]

101. Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents (December 1, 2007). From the US Department of Health and Human Services HIV/AIDS Information Services (AIDSinfo) website.

102. Shapiro ED, Wald ER. Efficacy of rifampin in eliminating pharyngeal carriage of Haemophilus influenzae type b. Pediatrics. 1980; 66:5-8. [IDIS 116632] [PubMed 6967587]

103. Gessert C, Granoff DM, Gilsdorf J. Comparison of rifampin and ampicillin in day care center contacts of Haemophilus influenzae type b disease. Pediatrics. 1980; 66:1-4. [IDIS 116631] [PubMed 6967580]

104. Horner DB, McCracken GH Jr, Ginsburg CM et al. A comparison of three antibiotic regimens for eradication of Haemophilus influenzae type b from the pharynx of infants and children Pediatrics. 1980; 66:136-8.

105. Cox F, Trincher R, Rissing JP et al. Rifampin prophylaxis of Haemophilus influenzae type b disease. JAMA. 1981; 245:1043-5. [IDIS 128158] [PubMed 6970272]

106. Murphy TV, Chrane DF, McCracken GH Jr et al. Rifampin prophylaxis v placebo for household contacts of children with Hemophilus influenzae type b disease. Am J Dis Child. 1983; 137:627-32. [IDIS 172374] [PubMed 6602542]

108. Elansary EH, Earis JE. Rifampin and adrenal crisis. BMJ. 1983; 286:1861-2. [IDIS 172184] [PubMed 6407604]

109. McAllister WAC, Thompson PJ, Al-Habet SM et al. Rifampin reduces effectiveness and bioavailability of prednisolone. BMJ. 1983; 286:923-5. [IDIS 168625] [PubMed 6403136]

110. Twum-Barima Y, Carruthers SG. Quinidine-rifampin interaction. N Engl J Med. 1981; 304:1466-9. [IDIS 131629] [PubMed 7231477]

111. Bussey HI, Merritt GJ, Hill EG. The influence of rifampin on quinidine and digoxin. Arch Intern Med. 1984; 144:1021-3. [IDIS 184760] [PubMed 6712395]

112. Meisel S, Pupkoff R, Svaan J. In vitro effect of rifampin on serum bilirubin determinations. Antimicrob Agents Chemother. 1980; 18:206-7. [IDIS 122137] [PubMed 7416745]

113. Baciewicz AM, Self TH. Rifampin drug interactions. Arch Intern Med. 1984; 144:1667-71. [IDIS 188706] [PubMed 6380442]

115. Girling DJ. Adverse effects of antituberculosis drugs. Drugs. 1982; 23:56-74. [IDIS 168183] [PubMed 6459920]

116. Stead WW, Dutt AK. An advance in treatment of tuberculosis. Ann Intern Med. 1980; 93:364-5. [IDIS 120608] [PubMed 7406386]

117. Anon. Drug-resistant tuberculosis among the homeless—Boston. MMWR Morb Mortal Wkly Rep. 1985; 34:429-31. [PubMed 3925317]

118. Livengood JR, Sigler TG, Foster LR et al. Isoniazid-resistant tuberculosis: a community outbreak and report of a rifampin prophylaxis failure. JAMA. 1985; 253:2847-9. [IDIS 199605] [PubMed 3989958]

119. Koplan JP, Farer LS. Choice of preventive treatment for isoniazid-resistant tuberculosis infection: use of decision analysis and the Dephi technique. JAMA. 1980; 244:2736-40. [IDIS 124861] [PubMed 6777513]

120. Allen RD, Hunnisett AG, Morris PJ. Cyclosporin and rifampicin in renal transplantation. Lancet. 1985; 1:980. [IDIS 199227] [PubMed 2859432]

121. Prober CG, Jadavji T, Soldin SJ. Effect of rifampin on chloramphenicol levels. N Engl J Med. 1985; 312:788-9. [IDIS 198165] [PubMed 3974656]

122. Peloquin CA, Namdar R, Singleton MD et al. Pharmacokinetics of rifampin under fasting conditions, with food, and with antacids. Chest. 1999; 115:12-8. [IDIS 424419] [PubMed 9925057]

123. Bolan G, Laurie RE, Broome CV. Red man syndrome: inadvertent administration of an excessive dose of rifampin to children in a day-care center. Pediatrics. 1986; 77:633-5. [IDIS 215197] [PubMed 3486402]

124. Centers for Disease Control and Prevention. Notice to readers: updated guidelines for the use of rifabutin or rifampin for the treatment and prevention of tuberculosis among HIV-infected patients taking protease inhibitors or nonnucleoside reverse transcriptase inhibitors. MMWR Morb Mortal Wkly Rep. 2000; 49:185-9. [IDIS 441965] [PubMed 11795500]

126. GlaxoSmithKline. Agenerase (amprenavir) capsules prescribing information. Research Triangle Park, NC; 2002 Oct.

127. Mayer TA, Bersoff-Matcha S, Murphy C et al. Clinical presentation of inhalational anthrax following bioterrorism exposure; report of 2 surviving patients. JAMA. 2001; 286:2549-53. [IDIS 472732] [PubMed 11722268]

128. Jacobson RR. Treatment. In: Hastings RC, ed. Leprosy. New York: Churchill Livingstone; 1985:193-222.

129. Report of a WHO Study Group. Chemotherapy of leprosy for control programmes. Technical Report Series No. 675. Geneva: World Health Organization; 1982:3-33.

131. Engelhard D, Stutman HR, Marks MI. Interaction of ketoconazole with rifampin and isoniazid. N Engl J Med. 1984; 311:1681-3. [IDIS 194105] [PubMed 6095080]

132. Doble N, Hykin P, Shaw R et al. Pulmonary Mycobacterium tuberculosis in acquired immune deficiency syndrome. BMJ. 1985; 291:849-50. [IDIS 205189] [PubMed 3931740]

133. Baohong J. Drug resistance in leprosy: a review. Lepr Rev. 1985; 56:265-78. [PubMed 3908861]

134. Immunization Practices Advisory Committee (ACIP). Update: prevention of Haemophilus influenzae type b disease. MMWR Morb Mortal Wkly Rep. 1986; 35:170-4, 179-80. [IDIS 212966] [PubMed 3081787]

135. Broome CV, Mortimer EA, Katz SL et al. Special report: use of chemoprophylaxis to prevent the spread of Haemophilus influenzae b in day-care facilities. N Engl J Med. 1987; 316:1226-8. [PubMed 3494944]

136. Osterholm MT, Pierson LM, White KE et al. The risk of subsequent transmission of Haemophilus influenzae type b disease among children in day care. N Engl J Med. 1987; 316:1-5. [PubMed 3491316]

137. Murphy TV, Clements JF, Breedlove JA et al. Risk of subsequent disease among day-care contacts of patients with systemic Haemophilus influenzae type b disease. N Engl J Med. 1987; 316:5-10. [PubMed 3491319]

138. Dashefsky B, Wald E, Li K. Management of contacts of children in day care with invasive Haemophilus influenzae type b disease. Pediatrics. 1986; 78:939-41. [PubMed 3489921]

139. US Army Medical Research Institute of Infectious Disease. USAMRIID’s medical management of biologic casualties handbook. 5th ed. USAMRIID: Fort Detrick, MD; 2004 Aug:25-31, D-1, D-2.

140. Broome CV, Mortimer EA Jr, Katz SL et al. Rifampin prophylaxis against Haemophilus influenzae type b. N Engl J Med. 1987; 317:1225.

141. Immunization Practices Advisory Committee (ACIP). Update: prevention of Haemophilus influenzae type b disease. MMWR Morb Mortal Wkly Rep. 1987; 36:529. [IDIS 232999] [PubMed 3112543]

142. Mehta J, Gandhi IS, Sane SB et al. Effect of clofazimine and dapsone on rifampin (Lositril) pharmacokinetics in multibacillary and paucibacillary leprosy cases. Indian J Lepr. 1985; 57:297-309. [PubMed 4078356]

143. Venkatesan K, Mathur A, Girdhar BK et al. The effect of clofazimine on the pharmacokinetics of rifampin and dapsone in leprosy. J Antimicrob Chemother. 1986; 18:715-8. [PubMed 3818497]

144. Broome CV, Mortimer EA, Katz SL et al. More on rifampin prophylaxis against Haemophilus influenzae b in day-care facilities. N Engl J Med. 1988; 318:48-9. [IDIS 236487] [PubMed 3257291]

145. Osterholm MT, Murphy TV. More on rifampin prophylaxis against Haemophilus influenzae b in day-care facilities. N Engl J Med. 1988; 318:49. [PubMed 3422102]

146. American Thoracic Society. Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventative strategies: a consensus statement. Am J Respir Crit Care Med. 1995; 153:1711-25.

147. Holdiness MR. Teratology of the antituberculosis drugs. Early Hum Dev. 1987; 15:61-74. [PubMed 3297625]

149. Good JT Jr, Iseman MD, Davidson PT et al. Tuberculosis in association with pregnancy. Am J Obstet Gynecol. 1981; 140:492-8. [IDIS 134114] [PubMed 7246682]

150. Snider DE, Johnson MW, Lyle MA et al. Treatment of tuberculosis during pregnancy. Am Rev Respir Dis. 1980; 122:989. [IDIS 128750] [PubMed 7458070]

151. Snider DE Jr, Layde PM, Johnson MW et al. Treatment of tuberculosis during pregnancy. Am Rev Respir Dis. 1980; 122:65-79. [IDIS 117330] [PubMed 6996549]

152. Abbott. Kaletra (lopinavir/ritonavir) capsules and oral solution prescribing information. North Chicago, IL. 2003 Jan.

153. Goldin HM, Schweitzer WJ, Bronson DM. Rifampin and exfoliative dermatitis. Ann Intern Med. 1987; 107:789. [IDIS 235765] [PubMed 2959187]

154. Holdiness MR. Adverse cutaneous reactions to antituberculosis drugs. Int J Dermatol. 1985; 24:280-5. [PubMed 2410379]

155. Nwokolo U. Acneiform lesions in combined rifampicin treatment in Africans. Br Med J. 1974; 3:473. [PubMed 4137745]

156. Nyirenda R, Gill GV. Stevens-Johnson syndrome due to rifampicin. Br Med J. 1977; 2:1189. [PubMed 589078]

157. Barbarash RA, Bauman JL, Fischer JH et al. Near-total reduction in verapamil bioavailability by rifampin. Chest. 1988; 94:954-9. [IDIS 310731] [PubMed 3180898]

158. Baciewicz AM, Self TH, Bekemeyer WB. Update on rifampin drug interactions. Arch Intern Med. 1987; 147:565-8. [IDIS 227165] [PubMed 2881523]

159. Rahn KH, Mooy J, Böhm R et al. Reduction of bioavailability of verapamil by rifampin. N Engl J Med. 1985; 312:920-1.

160. Barbarash RA. Verapamil–rifampin interaction. Drug Intell Clin Pharm. 1985; 19:559-60. [IDIS 202165] [PubMed 4028962]

161. Sanofi-Aventis. Rifadin (rifampin capsules) and Rifadin I (rifampin for injection) prescribing information. Bridgewater, NJ; 2007 Mar.

163. Ciba. Rimactane (rifampin) prescribing information. Summit, NJ; 1996 Apr.

164. Centers for Disease Control. Screening for tuberculosis and tuberculous infection in high-risk populations and the use of preventive therapy for tuberculous infections in the United States: recommendations of the Advisory Committee for Elimination of Tuberculosis (ACET). MMWR Recomm Rep. 1990; 39(RR-8):1-12.

165. Wallace RJ, Dunbar D, Brown BA et al. Rifampin-resistant Mycobacterium kansasii. Clin Infect Dis. 1994; 18:736-43. [IDIS 330106] [PubMed 8075262]

166. Bartlett JG, Dowell SF, et al. Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis. 2000; 31:347-82. [IDIS 454042] [PubMed 10987697]

167. US Centers for Disease Control and Prevention. Initial therapy for tuberculosis in the era of multidrug resistance. Recommendations of the Advisory Council for the Elimination of Tuberculosis MMWR Recomm Rep. 1993; 42(RR-7):1-8.

169. US Centers for Disease Control and Prevention. Prevention and control of tuberculosis in U.S. communities with at-risk minority populations and prevention and control of tuberculosis among homeless persons. MMWR Recomm Rep. 1992; 41(RR-5):1-23.

171. US Centers for Disease Control and Prevention. National action plan to combat multidrug-resistant tuberculosis. Meeting the challenge of multidrug-resistant tuberculosis: summary of a conference. Management of persons exposed to multidrug-resistant tuberculosis. MMWR Recomm Rep. 1992; 41(RR-11):1-71.

172. Sanofi-Aventis. Rifater (rifampin, isoniazid, and pyrazinamide) tablets prescribing information. Bridgewater, NJ; 2007 Mar.

175. Merck & Company Inc. Crixivan (indinavir sulfate) capsules prescribing information. West Point, PA; 2003 Jan.

176. American Academy of Pediatrics. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006.

177. US Public Health Service (USPHS) and Infectious Diseases Society of America (IDSA) Prevention of Opportunistic Infections Working Group. 2001 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons with human immunodeficiency virus. From the US Department of Health and Human Services HIV/AIDS Information Services (AIDSinfo) website.

178. Food and Drug Administration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414), to June 28, 1996. Rockville, MD: 1996 Jul.

179. Committee on Infectious Diseases, American Academy of Pediatrics Infectious Diseases and Immunization Committee, Canadian Paediatric Society. Meningococcal disease prevention and control strategies for practice-based physicians. Pediatrics. 1996; 97:404-12. [IDIS 361340] [PubMed 8604281]

180. CDC. Clinical update: impact of HIV protease inhibitors on the treatment of HIV-infected tuberculosis patients with rifampin. MMWR Morb Mortal Wkly Rep. 1996; 45:921-5. [IDIS 374018] [PubMed 8927017]

181. Horsburgh CR Jr. Advances in the prevention and treatment of Mycobacterium avium disease. N Engl J Med. 1996; 335:428-30. [IDIS 369569] [PubMed 8663875]

182. Havlir DV, Dube MP, Sattler FR et al. Prophylaxis against disseminated Mycobacterium avium complex with weekly azithromycin, daily rifabutin, or both. N Engl J Med. 1996; 335:392-8. [IDIS 369567] [PubMed 8676932]

183. Sun E, Heath-Chiozzi M, Cameron DW et al. Concurrent ritonavir and rifabutin increase risk of rifabutin-associated adverse event. Presented at the XI International Conference on AIDS. Vancouver, BC, July 8, 1996. Abstract B171.

184. Griffith DE, Brown BA, Girard WM et al. Adverse events associated with high-dose rifabutin in macrolide-containing regimens for the treatment of M. avium complex lung disease. Clin Infect Dis. 1995; 21:594-8. [IDIS 354819] [PubMed 8527549]

185. National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing: twelfth informational supplement. NCCLS document M100-S12. Wayne, PA; 2002 Jan.

186. Aubry-Damon H, Galimand M, Gerbaud G et al. rpoB mutation conferring rifampin resistance in Streptococcus pyogenes. Antimicrob Agents Chemother. 2002; 46:1571-3. [PubMed 11959602]

187. Centers for Disease Control and Prevention. Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005; 54(RR-7):1-21.

188. Centers for Disease Control and Prevention. Control and prevention of serogroup C meningococcal disease: evaluation and management of suspected outbreaks: recommendation of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997; 46(RR-5):13-21. [PubMed 9048847]

189. Jackson LA, Alexander ER, Debolt CA et al. Evaluation of the use of mass chemoprophylaxis during a school outbreak of enzyme type 5 serogroup B meningococcal disease. Pediatr Infect Dis J. 1996; 15:992-8. [IDIS 376843] [PubMed 8933547]

190. Abadi FJR, Carter PE, Cash P et al. Rifampin resistance in Neisseria meningitidis due to alterations in membrane permeability. Antimicrob Agents Chemother. 1996; 40:646-51. [PubMed 8851587]

191. Griffith DE, Aksamit T, Brown-Elliott BA et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007; 175:367-416. [PubMed 17277290]

192. Agouron Pharmaceuticals. Viracept (nelfinavir mesylate) tablets and oral powder prescribing information. La Jolla, CA; 2003 Apr.

193. Berning SE, Iseman MD. Rifamycin-induced lupus syndrome. Lancet. 1997; 349:1521-2. [IDIS 385835] [PubMed 9167470]

194. Centers for Disease Control and Prevention. Prevention and treatment of tuberculosis among patients infected with human immunodeficiency virus: principles of therapy and revised recommendations. MMWR Recomm Rep. 1998; 47(RR-20):1-58.

195. Centers for Disease Control and Prevention. Use of short-course tuberculosis preventive therapy regimens in HIV-seronegative patients. MMWR Morb Mortal Wkly Rep. 1998; 47:911-2.

196. Bishai WR, Chaisson RE. Short-course chemoprophylaxis for tuberculosis. Clin Chest Med. 1997; 18:115-22. [PubMed 9098615]

197. Centers for Disease Control and Prevention. Tuberculosis/Mycobacteriology Branch: 1998 Nov 6 from CDC web site.

198. WHO Expert Committee on Leprosy. Seventh Report. WHO Technical Report Series No. 874. Geneva: World Health Organization; 1998:1-43.

199. Whitty CJ, Lockwood DN. Leprosy—New perspectives on an old disease. J Infect. 1999; 38:2-5. [IDIS 424615] [PubMed 10090496]

200. Jacobson RR, Krahenbuhl JL. Leprosy. Lancet. 1999; 353:655-60. [IDIS 421539] [PubMed 10030346]

201. MacDougall AC, Ulrich MI. Mycobacterial Disease: Leprosy. In: Fitzpatrick TB, Eisen AZ, Wolff K et al, eds. Dermatology in General Medicine, 4th ed. New York, NY: McGraw -Hill Inc; 1993:2395-2410.

202. Panda S. Let’s learn some clinical facts on leprosy - before it is eradicated. Bull on Drug Health Information (India). 1998; 5:5-12.

203. Anon. Choice of antibacterial drugs Med Lett Treat Guidel. 2004; 13-26.

204. Anon. Essential Drugs. WHO Model Formulary. Antibacterials. Antileprosy Drugs. WHO Drug Information. 1997; 11:253.

205. WHO Study Group on Chemotherapy of Leprosy. Seventh Report. WHO Technical Report Series No. 847. Geneva: World Health Organization; 1994:1-24.

206. WHO. Action Programme for the elimination of leprosy (LEP). From WHO Website. 1999 Sept 23.

207. WHO. Reports on individual drugs. Simplified treatment for leprosy. WHO Drug Information. 1997; 11:131 (IDIS 397127).

208. Ji B, Jamet P, Perani EG et al. Bactericidal activity of single dose of clarithromycin plus minocycline, with or without ofloxacin, against Mycobacterium leprae in patients. Antimicrob Agents Chemother. 1996; 40:2137-41. [IDIS 373246] [PubMed 8878595]

209. Ji B, Perni EG, Petinom C et al. Bactericidal activities of combinations of new drugs against Mycobacterium leprae in nude mice. Antimicrob Agents Chemother. 1996; 40:393-9. [PubMed 8834886]

210. Anon. Leprosy beyond the year 2000. Lancet. 1997; 350:1717. [PubMed 9413456]

211. John TJ. Leprosy beyond the year 2000. Lancet. 1998; 351:756. [PubMed 9504547]

212. Single-lesion Multicentre Trial Group. Efficacy of single-dose multidrug therapy for the treatment of single-lesion paucibacillary leprosy. Indian J Leprosy. 1997; 69:121-9.

213. Forest Pharmaceuticals, Inc. Tiazac (diltiazem hydrochloride) extended release capsules prescribing information. St. Louis, MO; 1999 October.

214. Diltiazem (Cardizem) drug interaction: Rifampin (Rifadin). In: Hansten PD, Horn JR. Drug interactions analysis and management. Vancouver, WA: Applied Therapeutics, Inc; 1997:245.

215. American Thoracic Society (ATS) and Centers for Disease Control Prevention (CDC). Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med. 2000; 161:S221-S247.

216. Abbott Laboratories. Norvir (ritonavir) soft gelatin capsules and oral solution prescribing information. North Chicago, IL; 2001 Sept.

217. Agouron. Rescriptor (delavirdine mesylate) tablets prescribing information. La Jolla, CA; 2001 Jun 8.

218. Bristol-Myers Squibb. Sustiva (efavirenz capsules) prescribing information. Princeton, NJ; 2003 Apr.

219. Boehringer Ingelheim. Viramune (nevirapine) tablets prescribing information. Ridgefield, CT; 2002 Dec 20.

220. Roche. Invirase (saquinavir mesylate) capsules prescribing information. Nutley, NJ; 2002 Jul.

221. Roche. Fortovase (saquinavir) soft gelatin capsules prescribing information. Nutley, NJ; 2002 Jul.

222. Centers for Disease Control and Prevention. Fatal and severe hepatitis associated with rifampin and pyrazinamide for the treatment of latent tuberculosis infection—New York and Georgia, 2000. MMWR Morb Mortal Wkly Rep. 2001; 50:289-91. [IDIS 463131] [PubMed 11330495]

223. Brodie MJ, Boobis AR, Hillyard CJ et al Effect of rifampicin and isoniazid on vitamin D metabolism. Clin Pharmacol Ther. 1982; 32:525-30.

224. Centers for Disease Control and Prevention. Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: recommendations of CDC, the Infectious Diseases Society of America, and the American Society of Blood and Marrow Transplantation. MMWR Recomm Rep. 2000; 49(RR-10):1-125.

225. Centers for Disease Control and Prevention. Update: fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in American Thoracic Society/CDC recommendations—United States, 2001. MMWR Morb Mortal Wkly Rep. 2001; 50:733-5. [IDIS 469163] [PubMed 11787580]

226. Bartlett JG, Dowell SF, Mandell LA et al. Guidelines from the Infectious Diseases Society of America: practice guidelines for management of community-acquired pneumonia in adults. Clin Infect Dis. 2000; 31:347-82. [IDIS 454042] [PubMed 10987697]

227. Agalar C, Usubutun S, Turkyilmaz R. Ciprofloxacin and rifampicin versus doxycycline and rifampicin in the treatment of brucellosis. Eur J Clin Microbiol Infect Dis. 1999; 18:535-8. [PubMed 10517189]

228. Solera J, Martinez-Alfaro E, Espinosa A Recognition and optimum treatment of brucellosis. Drugs. 1997; 53:245-56.

229. Solera J, Rodriguez-Zapata M, Geijo P et al. Doxycycline-rifampin versus doxycycline-streptomycin in treatment of human brucellosis due to Brucella melitensis. Antimicrob Agents Chemother. 1995; 39:2061-7. [IDIS 353842] [PubMed 8540716]

230. Ariza J, Gudiol F, Pallares R et al. Treatment of human brucellosis with doxycycline plus rifampin or doxycycline plus streptomycin: a randomized, double-blind study. Ann Intern Med. 1992; 117:25-30. [IDIS 298554] [PubMed 1596044]

231. Colmenero JD, Fernandez-Gallardo LC, Agundez JAG et al. Possible implications of doxycycline-rifampin interaction for treatment of brucellosis. Antimicrob Agents Chemother. 1994; 38:2798-802. [IDIS 339761] [PubMed 7695265]

232. Stout JE, Yu VL. Legionellosis. N Engl J Med. 1997; 337:682-7. [IDIS 390617] [PubMed 9278466]

233. Conrad DA. Treatment of cat-scratch disease. Curr Opin Pediatr. 2001; 13:56-9. [PubMed 11176245]

234. Cunningham ET, Koehler JE. Ocular bartonellosis. Am J Ophthalmol. 2000; 130:340-9. [PubMed 11020414]

235. Reed JB, Scales DK, Wong MT et al. Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae. Ophthalmology. 1998; 105:459-66. [PubMed 9499776]

236. Tan JS. Human zoonotic infections transmitted by dogs and cats. Arch Intern Med. 1997; 157:1933-43. [IDIS 394193] [PubMed 9308505]

237. Bass JW, Freitas BC, Freitas AD et al. Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease. Pediatr Infect Dis J. 1998; 17:447-52. [IDIS 408829] [PubMed 9655532]

238. Smith DL. Cat-scratch disease and related clinical syndromes. Am Fam Physician. 1997; 55:1783-9. [IDIS 384830] [PubMed 9105205]

239. Tsang KW, Lam PS, Yuen KY et al. Rhodococcus equi lung abscess complicating Evan's syndrome treated with corticosteroids. Respiration. 1998; 65:327-30. [PubMed 9730805]

240. Capdevila JA, Bujan S, Gavalda J et al. Rhodococcus equi pneumonia in patients infected with the human immunodeficiency virus: report of 2 cases and review of the literature. Scand J Infect Dis. 1997; 29:535-41. [PubMed 9571730]

241. Horowitz HW, Hsieh TC, Aquero-Rosenfeld ME et al. Antimicrobial susceptibility of Ehrlichia phagocytophila. Antimicrob Agents Chemother. 2001; 45:786-9. [PubMed 11181361]

242. Drayton J, Dickinson G, Rinaldi MG. Coadministration of rifampin and itraconazole leads to undetectable levels of serum itraconazole. Clin Infect Dis. 1994; 18:266. [IDIS 325368] [PubMed 8161649]

243. Offermann G, Keller F, Molzahn M. Low cyclosporin A blood levels and acute graft rejection in a renal transplant recipient during rifampin treatment. Am J Nephrol. 1985; 5:385-7. [PubMed 3904451]

244. Modry DL, Stinson EB, Oyer PE et al. Acute rejection and massive cyclosporine requirements in heart transplant recipients treated with rifampin. Transplantation. 1985; 39:313-4. [PubMed 3883596]

245. Zylber-Katz E. Multiple drug interactions with cyclosporine in a heart transplant patient. Ann Pharmacother. 1995; 29:127-31. [IDIS 342847] [PubMed 7756709]

246. Chenhsu RY, Loong CC, Chou MH et al. Renal allograft dysfunction associated with rifampin-tacrolimus interaction. Ann Pharmacother. 2000; 34:27-31. [IDIS 439888] [PubMed 10669182]

247. Gillum JG, Sesler JM, Bruzzese VL et al Induction of theophylline clearance by rifampin and rifabutin in healthy male volunteers. Antimicrob Agents Chemother. 1996; 40:1866-9.

248. Joos AAB, Frank UG, Kaschka WP. Pharmacokinetic interaction of clozapine and rifampicin in a forensic patient with an atypical mycobacterial infection. J Clin Pharmacol. 1998; 18:83-5.

249. Villikka K, Kivisto KT, Backman JT et al. Triazolam is ineffective in patients taking rifampin. Clin Pharmacol Ther. 1997; 61:8-14. [IDIS 379530] [PubMed 9024169]

250. Backman JT, Olkkola KT, Neuvonen PJ. Rifampin drastically reduces plasma concentrations and effects of oral midazolam. Clin Pharmacol Ther. 1996; 59:7-13. [IDIS 360356] [PubMed 8549036]

251. Gallicano KD, Sahai J, Shukla VK et al. Induction of zidovudine glucuronidation and amination pathways by rifampicin in HIV-infected patients. Br J Clin Pharmacol. 1999; 48:168-79. [IDIS 432032] [PubMed 10417493]

252. Centers for Disease Control and Prevention. Update: investigation of bioterrorism-related anthrax and interim guidelines for exposure management and antimicrobial therapy, October 2001. MMWR Morb Mortal Wkly Rep. 2001; 50:909-19. [IDIS 471910] [PubMed 11699843]

253. Centers for Disease Control and Prevention. Update: investigation of bioterrorism-related anthrax and interim guidelines for clinical evaluation of persons with possible anthrax. MMWR Morb Mortal Wkly Rep. 2001; 50:941-8. [PubMed 11708591]

254. Inglesby TV, O'Toole T, Henderson DA et al for the Working Group on Civilian Biodefense. Anthrax as a biological weapon, 2002. Updated recommendations for management. JAMA. 2002; 287:2236-52. [IDIS 480001] [PubMed 11980524]

255. Centers for Disease Control and Prevention. Update: investigation of bioterrorism-related anthrax and interim guidelines for clinical evaluation of persons with possible anthrax. MMWR Morb Mortal Wkly Rep. 2001; 50:941-8. [PubMed 11708591]

256. Bristol-Myers Squibb. Reyataz (atazanavir sulfate) prescribing information. Princeton, NJ; 2003 Jun.

257. Centers for Disease Control and Prevention. Update: adverse event data and revised American Thoracic Society/CDC recommendations against the use of rifampin and pyrazinamide for treatment of latent tuberculosis infection—United States, 2003. MMWR Morb Mortal Wkly Rep. 2003; 52:735-9. [PubMed 12904741]

258. Centers for Disease Control and Prevention. Treatment of tuberculosis, American Thoracic Society, CDC, and Infectious Diseases Society of America. MMWR Recomm Rep. 2003; 52(RR-11):1-77.

259. Sanofi-Aventis. Rifamate (rifampin and isoniazid) capsules USP prescribing information. Bridgewater, NJ; 2007 Mar.

260. Birgerson LE. Dear health care provider letter regarding an important drug interaction between ritonavir-boosted saquinavir and rifampin. Nutley, NJ: Roche Laboratories. From Roche web site; accessed 2005 Feb 11.

261. GlaxoSmithKline. Malarone (atovaquone and proguanil hydrochloride) tablets and pediatric tablets prescribing information. Research Triangle Park, NC; 2003 Dec.

262. Pfizer. Diflucan (fluconazole) tablets, injection for intravenous infusion only, and for oral suspension prescribing information. New York, NY; 2004 Aug.

263. Coker RJ, Tomlinson DR, Parkin J et al. Interaction between fluconazole and rifampicin. Br Med J. 1990; 301:818.

264. Janssen Pharmaceutica. Sporanox (itraconazole) capsules prescribing information. Titusville, NJ: 2004 Jan.

265. Janssen Pharmaceutica. Nizoral (ketoconazole) tablets prescribing information. Titusville, NJ; 1998 Jul.

266. Fraser A, Gafter-Gvili A, Paul M et al. Prophylactic use of antibiotics for prevention of meningococcal infections: systematic review and meta-analysis of randomised trials. Eur J Clin Microbiol Infect Dis. 2005; 24:172-81. [PubMed 15782277]

267. Anon. Drugs for pneumonia. Med Lett Treat Guid. 2003; 1:83-8.

268. Yogev R, Guzman-Cottrill J. Bacterial meningitis in children. Critical review of current concepts. Drugs. 2005; 65:1097-112. [PubMed 15907145]

269. Pediatric Tuberculosis Collaborative Group. Targeted tuberculin skin testing and treatment of latent tuberculosis infection in children and adolescents. Pediatrics. 2004; 114:1175-1209.

270. Pappas G, Akritidis N, Bosilkovski M et al. Brucellosis. N Engl J Med. 2005; 352:2325-36. [IDIS 533610] [PubMed 15930423]

271. Droste JA, Wissen V, Kearney BP et al. Pharmacokinetic study of tenofovir disoproxil fumarate combined with rifampin in healthy volunteers. Antimicrob Agents Chemother. 2005; 49:680-4. [IDIS 529691] [PubMed 15673751]

272. Patel IH, Zhang X, Nieforth K et al. Pharmacokinetics, pharmacodynamics and drug interaction potential of enfuvirtide. Clin Pharmacokinet. 2005; 44:175-86. [PubMed 15656696]

a. AHFS drug information 2007. McEvoy GK. Rifampin. Bethesda, MD. American Society of Health-System Pharmacists;2007:566-77.

b. Bedford laboratories. Rifampin for injection USP prescribing information. Bedford, OH; 2004 Feb.

c. Boehringer Ingelheim. Aptivus (tipranavir) capsules prescribing information. Ridgefield, CT; 2006 Jun 17.

d. Working Group on Antiretroviral Therapy and Medical Management of HIV-infected Children of the National Pediatric and Family HIV Resource Center (NPHRC), Health Resources and Services Administration (HRSA), and National Institutes of Health (NIH). Guidelines for the use of antiretroviral agents in pediatric HIV infection (June 25, 2003). From the US Department of Health and Human Services HIV/AIDS Information Services (AIDSinfo) website.

f. Genentech. Tarceva (erlotinib) tablets prescribing information. South San Francisco, CA; 2007 Mar.

g. Presutti Laboratories. Tindamax (tinidazole tablets) prescribing information. Arlington Heights, IL; 2004 May 14.

h. Sanofi-Aventis. Ketek (telithromycin) tablets prescribing information. Bridgewater, NJ; 2007 Feb.

i. GlaxoSmithKline. Avandia (rosiglitazone maleate) tablets prescribing information. Research Triangle Park, NC; 2007 Jun.

j. Mallolas J, Sarasa M, Nomdedeu M et al. Pharmacokinetic interaction between rifampicin and ritonavir-boosted atazanavir in HIV-infected patients. HIV Med. 2007; 8:131-4. [PubMed 17352770]

k. Wormser GP, Dattwyler RJ, Shapiro ED et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006; 43:1089-134. [PubMed 17029130]

l. Branger S, Rolain MJ, Raoult D. Evaluation of antibiotic susceptibilities of Ehrlichia canis, Ehrlichia chaffeensis, and Anaplasma phagocytophilum by real-time PCR. Antimicrob Agents Chemother. 2004; 48:4822-8. [PubMed 15561862]

m. Merck & Co, Inc. Cancidas (caspofungin acetate) for injection prescribing information. Whitehouse Station, NJ; 2005 Feb.

n. Astellas Pharma US. Mycamine (micafungin sodium) for injection prescribing information. Deerfield, IL; 2006 Jun.

o. Pfizer. Vfend (voriconazole) injection, tablets, and for oral suspension injection prescribing information. New York, NY; 2006 Mar.

p. Roerig. Eraxis (anidulafungin) for injection prescribing information. New York, NY; 2007 May.

q. Stone JA, Migoya EM, Hickey L et al. Potential for interactions between caspofungin and nelfinavir or rifampin. Antimicrob Agents Chemother. 2004; 48:4306-14. [PubMed 15504857]

r. Centers for Disease Control and Prevention. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. MMWR Recomm Rep. 2004; 53(RR-15):1-112.

s. Centers for Disease Control and Prevention. Treating opportunistic infections among HIV-exposed and infected children: recommendations from CDC, the National Institutes of Health, and the Infectious Diseases Society of America. MMWR Recomm Rep. 2004; 53(RR-14):1-92.

t. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep. 2005; 54 (RR-17):1-141.

u. Centers for Disease Control and Prevention. Prevention and control of tuberculosis in correctional and detention facilities: recommendations from CDC. MMWR Recomm Rep. 2006; 55 (RR-9):1-44.

v. Blumberg HM, Leonard MK, Jasmer RM. Update on the treatment of tuberculosis and latent tuberculosis infection. JAMA. 2005; 293:2776-84. [PubMed 15941808]

w. World Health Organization. Extensively drug-resistant tuberculosis (XDR-TB): recommendations for prevention and control. Wkly Epidemiol Rec. 2006; 45:430-2.

x. Gandhi NR, Moll A, Sturm AW et al. Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet. 2006; 368:1575-80. [PubMed 17084757]

y. Aziz MA, Wright A, Laszlo A et al. Epidemiology of antituberculosis drug resistance (the global project on anti-tuberculosis drug resistance surveillance): an updated analysis. Lancet. 2006; 368:2142-54. [PubMed 17174706]

z. Centers for Disease Control and Prevention. Extensively drug-resistant tuberculosis–United States, 1993-2006. MMWR Morb Mortal Wkly Rep. 2007; 56:250-3. [PubMed 17380107]

aa. Jacobus Pharmaceutical Co. Paser granules (aminosalicylic acid granules) prescribing information. Princeton, NJ; 1996 Jul.

bb. Rallis E, Koumantaki-Mathioudaki E. Treatment of Mycobacterium marinum cutaneous infections. Exp Opin Pharmacother. 2007; 8:2965-78.

cc. Lewis FM, Marsh BJ, von Reyn CF. Fish tank exposure and cutaneous infections due to Mycobacterium marinum: tuberculin skin testing, treatment, and prevention. Clin Infect Dis. 2003; 37:390-7. [PubMed 12884164]

dd. Aubry A, Jarlier V, Escolano S et al. Antibiotic susceptibility pattern of Mycobacterium marinum. Antimicrob Agents Chemother. 2000; 44:3133-6. [PubMed 11036036]

ee. Pfizer. Selzentry (maraviroc) tablets prescribing information. New York, NY; 2007 Aug.

ff. Edelstein H. Mycobacterium marinum skin infections. Report of 31 cases and review of the literature. Arch Intern Med. 1994; 154:1359-64. [PubMed 8002687]

gg. GlaxoSmithKline. Mepron (atovaquone) suspension prescribing information. Research Triangle Park, NC; 2006 Nov.

hh. Jacobus Pharmaceutical Company Inc. Dapsone tablets USP prescribing information. Princeton, NJ; 1997 Jun.

ii. Daher R, Haidar JH, Al-Amin H. Rifampin interference with opiate immunoassays. Clin Chem. 2002; 48:203-4. [PubMed 11751562]

jj. World Health Organization. WHO recommended multidrug therapy (MDT) regimens. From the WHO website. Accessed 2008 Jan 7.

kk. National Hansen's Disease (Leprosy) Program. From the US Department of Health and Human Services website. Accessed 2008 Jan 7.

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007: 1462-3.

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