101
|
Hmouda H, Laouani-Kechrid C, Nejib Karoui M, Denguezli M, Nouira R, Ghannouchi G. A Rare Case of Streptomycin-Induced Toxic Epidermal Necrolysis in a Patient with Tuberculosis: A Therapeutic Dilemma. Ann Pharmacother 2005; 39:165-8. [PMID: 15546942 DOI: 10.1345/aph.1e430] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To report a case of streptomycin-induced toxic epidermal necrolysis (TEN). CASE SUMMARY: A 55-year-old woman was admitted for treatment of active pulmonary tuberculosis (TB). She was given standard oral anti-TB chemotherapy including isoniazid, rifampin, pyrazinamide, and streptomycin. On the fourth day of therapy, she experienced high fever at 39 °C, chills, vomiting, pruritus, and diffuse erythema, followed by extensive bullae formation and skin denudation. Diagnosis of TEN was considered, and all anti-TB drugs were discontinued. Skin biopsy disclosed complete epidermal necrosis with dermal—epidermal cleavage and absence of inflammatory infiltrate, highly suggestive of TEN. The patient was transferred to the intensive care unit. Her general condition and skin lesions improved. A staged-fashion exposure test to the 4 anti-TB drugs allowed the incrimination of streptomycin as the offending agent. DISCUSSION: Anti-TB drugs, mainly rifampin, ethambutol, and isoniazid, have been incriminated in TEN. Streptomycin-induced TEN remains an extremely rare event. However, minor allergic skin reactions (rash, urticaria) have been described with this drug. Our patient presents a rare case of streptomycin-related TEN. Even though dangerous, a step-wise exposure test was necessary to allow safe treatment of active pulmonary TB. It also provided a strong argument of a cause—effect relationship between TEN and streptomycin. An objective causality assessment using the Naranjo rating scale revealed that the adverse drug event was highly probable. CONCLUSIONS: Streptomycin should be added to the list of drugs that induce TEN.
Collapse
Affiliation(s)
- Houssem Hmouda
- Medical Intensive Care Unit and Emergency Department, Sahloul University Hospital, Sousse, Tunisia.
| | | | | | | | | | | |
Collapse
|
102
|
Affiliation(s)
- Omar Khokhar
- Division of Gastroenterology, Department of Medicine, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007, USA.
| | | | | | | |
Collapse
|
103
|
Abstract
Nitroaromatic antibiotics have a long and controversial history in human and veterinary medicine. This controversy lies behind the presumption of many pharmaceutical companies that nitroaromatic compounds should be filtered from the list of drug-like compounds but stands at odds with the remarkably safe clinical record of use of such compounds. In this review, we will describe the whole-cell structure-activity relationships that have been reported for antimycobacterial nitroimidazoles as well as the available in vivo data supporting efficacy with a particular emphasis on nitroimidazo[2,1-b]oxazines such as PA-824. We will also explore the unique potential of such compounds to shorten the course of tuberculosis therapy by exerting a bactericidal effect on non-replicating bacilli. We will consider the mode of action of such compounds in sensitive organisms and discuss the mechanisms by which resistance may emerge. Finally, we will review the pharmacokinetics, toxicology and laboratory and animal studies linking nitroimidazoles with carcinogenicity and mutagenicity and assess the prospects for the clinical introduction of nitroimidazoles for the treatment of tuberculosis.
Collapse
Affiliation(s)
- Clifton E Barry
- Tuberculosis Research Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD 20852, USA.
| | | | | |
Collapse
|
104
|
Abstract
Pseudomembranous colitis is known to develop with long-term antibiotic administration, but antitubercular agents are rarely reported as a cause of this disease. We experienced a case of pseudomembranous colitis associated with rifampin. The patient was twice admitted to our hospital for the management of frequent bloody, mucoid, jelly-like diarrhea and lower abdominal pain that developed after antituberculosis therapy that included rifampin. Sigmoidoscopic appearance of the rectum and sigmoid colon and mucosal biopsy were compatible with pseudomembranous colitis. The antitubercular agents were discontinued and metronidazole was administered orally. The patient's symptoms were resolved within several days. The antituberculosis therapy was changed to isoniazid, ethambutol and pyrazinamide after a second bout of colitis. The patient had no further recurrence of diarrhea and abdominal pain. We report here on a case of pseudomembranous colitis associated with rifampin.
Collapse
Affiliation(s)
| | | | | | | | - Seok Chan Kim
- Correspondence to : Seok Chan Kim, M.D., Division of Pulmonology, Department of Internal Medicine, Dae-Jeon St. Mary’s Hospital, 520-2 Daeheung-dong, Jung-gu, Daejeon, 301-723, Korea Tel : 042-220-9507, 9829, Fax : 042-226-9137, E-mail :
| |
Collapse
|
105
|
Patel A, Patel K, Patel J, Shah N, Patel B, Rani S. Safety and Antiretroviral Effectiveness of Concomitant Use of Rifampicin and Efavirenz for Antiretroviral-Naive Patients in India Who Are Coinfected With Tuberculosis and HIV-1. J Acquir Immune Defic Syndr 2004; 37:1166-9. [PMID: 15319677 DOI: 10.1097/01.qai.0000135956.96166.f0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the safety and antiretroviral effectiveness of concomitant use of rifampicin and efavirenz for antiretroviral-naïve patients in India who are coinfected with tuberculosis (TB) and HIV-1. DESIGN AND METHODS The study was an observational longitudinal cohort investigation. HIV-1-infected patients with CD4 cell counts of < or = 200/microL who attended the Infectious Disease Clinic of Sterling Hospital (Ahmedabad, India) from June 2001 to December 2002 were recruited for the study. Patients were divided in 2 groups: group A, patients with active TB (n = 126); and group B, patients without TB (n = 129). Group A patients were given efavirenz with 2 nucleoside reverse transcriptase inhibitors along with rifampicin-containing anti-TB treatment. Group B patients were treated for presenting opportunistic infections and started therapy with efavirenz plus 2 nucleoside reverse transcriptase inhibitors. The nucleoside reverse transcriptase inhibitors were either zidovudine and lamivudine (n = 30) or stavudine and lamivudine (n = 225). Patients self-funded their investigations and medications (antiretroviral, anti-TB, and other opportunistic infection-related agents). Indian generic medications were used. RESULTS Efavirenz-based highly active antiretroviral therapy with rifampicin for HIV/TB-coinfected patients resulted in an immunologic response that was comparable with that of the group not receiving rifampicin. Median CD4 cell counts at baseline, 3 months, 6 months, and 9 months in group A were 84/microL (range, 5-200/microL), 225/microL (range, 26-528/microL), 251/microL (range, 65-775/microL), and 275/microL (range, 61-611/microL), respectively, and in group B, these values were 118/microL (range, 2-200/microL), 244/microL (range, 38-881/microL), 294/microL (range, 23-1322/microL), and 295/microL (range, 26-991/microL), respectively. The overall increase in CD4 cell count was greater in group A than in group B at 9 months (190 vs. 176/microL, respectively). Patients in both groups tolerated the therapy well; the adverse effects profile was comparable except that group A patients had a higher incidence of hepatitis than group B patients (13.49% vs. 0, respectively; P < 0.0001). CONCLUSION Clinical and immunologic benefits are comparable for patients receiving efavirenz-based antiretroviral therapy with or without rifampicin.
Collapse
Affiliation(s)
- Atul Patel
- Chief Division of Infectious Disease, Sterling Hospital, Ahmedabad, India.
| | | | | | | | | | | |
Collapse
|
106
|
Abstract
A 56-year-old Jewish woman of Ashkenazi origin had a history of tuberculosis since the age of 1 year, contracted while she was in hiding in Poland during the Holocaust. She developed bronchiectasis in 1972 for which she was being treated 4 times a year for 1-month periods with 600 mg/d rifampin. During the Persian Gulf War in February 1991, a month after a rifampin treatment, she was admitted to the dermatology department with cutaneous and oral mucous eruptions. Physical examination revealed crusting bullae and erosions on the trunk and lower limbs. The mucous membranes were affected in the vagina, oral cavity, and pharynx. Histologic and immunofluorescence studies on a biopsy specimen confirmed the diagnosis of pemphigus vulgaris. There was no family history of the disease. Systemic treatment with prednisone,100 mg/d, resulted in regression of the eruption within a month, and the dose was tapered to 10 mg every second day. Although she received anti-tuberculosis treatment, the steroids caused an exacerbation of the tuberculosis, and after a massive hemoptysis in 1993, a right upper and middle lobectomy was performed. The operation put an end to the vicious cycle of drug-induced pemphigus outbreaks by eliminating the need for rifampin, but the patient reported the appearance of new lesions during periods of emotional stress.
Collapse
Affiliation(s)
- Ilan Goldberg
- Department of Dermatology, Tel Aviv Sourasky Medical Center,6 Weizmann Street, Tel Aviv 64239, Israel
| | | | | |
Collapse
|
107
|
|
108
|
Abstract
Severe hypoglycaemia requiring more than 20 mg/kg per minute glucose infusion was seen in a premature infant. The infant was born to a woman with active tuberculosis, and she was on prophylactic isoniazid. Discontinuation of isoniazid resulted in prompt recovery of hypoglycaemia. Further pharmacological studies may be needed to establish a cause and effect relationship.
Collapse
Affiliation(s)
- F Ovali
- Neonatal Unit, Department of Obstetrics and Gynecology, Istanbul Medical Faculty, Istanbul University, Turkey.
| | | | | | | |
Collapse
|
109
|
van Hest R, Baars H, Kik S, van Gerven P, Trompenaars MC, Kalisvaart N, Keizer S, Borgdorff M, Mensen M, Cobelens F. Hepatotoxicity of rifampin-pyrazinamide and isoniazid preventive therapy and tuberculosis treatment. Clin Infect Dis 2004; 39:488-96. [PMID: 15356811 DOI: 10.1086/422645] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Accepted: 03/27/2004] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Severe liver injury has been attributed to preventive treatment of latent tuberculosis infection with a 2-month course of rifampin-pyrazinamide. METHODS A retrospective cohort study in The Netherlands compared the hepatotoxicity of preventive treatment with rifampin-pyrazinamide with that of preventive treatment with isoniazid, and also with that of treatment for active tuberculosis containing at least isoniazid, rifampin, and pyrazinamide. RESULTS Preventive treatment with rifampin-pyrazinamide caused severe hepatotoxicity more often than did preventive treatment with isoniazid (odds ratio [OR], 2.61; 95% confidence interval [CI], 1.26-5.39; P=.012), especially in patients <25 years old. It also caused severe hepatotoxicity more often than triple- or quadruple-drug tuberculosis treatment (OR, 2.61; 95% CI, 1.21-5.59; P=.016), especially if the pyrazinamide dose was > or =30 mg/kg. Preventive treatment with rifampin-pyrazinamide was more hepatotoxic even when the advised pyrazinamide dose of up to 20 mg/kg for preventive treatment was compared with the pyrazinamide dose of 30 mg/kg for tuberculosis treatment. CONCLUSIONS Preventive treatment with rifampin-pyrazinamide causes severe hepatotoxicity more often than does preventive treatment with isoniazid or curative treatment for tuberculosis.
Collapse
Affiliation(s)
- Rob van Hest
- Department of Tuberculosis Control, Municipal Health Service, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
110
|
Tsankov N, Angelova I. Rifampin in dermatology. Dis Mon 2004; 50:369-80. [PMID: 15280868 DOI: 10.1016/j.disamonth.2004.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
111
|
Abstract
A 2-month regimen of rifampin and pyrazinamide (2RZ) became an accepted alternative for treatment of latent tuberculosis (TB) after initial studies in HIV-seropositive patients demonstrated safety and efficacy. Once this alternative came into widespread use, however, a number of cases of severe and fatal hepatitis associated with 2RZ were reported. Although the initial experience with HIV-seropositive patients was encouraging, subsequent research demonstrated that the risk of 2RZ-associated hepatitis is considerably greater than the risk of hepatitis associated with isoniazid treatment for latent TB. Updated guidelines now recommend only restricted use of the 2RZ regimen for latent TB, with careful supervision.
Collapse
Affiliation(s)
- Jason E Stout
- Department of MEdicine, Duke University Medical Center, Durham, NC 27710, USA.
| |
Collapse
|
112
|
la Porte CJL, Colbers EPH, Bertz R, Voncken DS, Wikstrom K, Boeree MJ, Koopmans PP, Hekster YA, Burger DM. Pharmacokinetics of adjusted-dose lopinavir-ritonavir combined with rifampin in healthy volunteers. Antimicrob Agents Chemother 2004; 48:1553-60. [PMID: 15105105 PMCID: PMC400571 DOI: 10.1128/aac.48.5.1553-1560.2004] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Coadministration of lopinavir-ritonavir, an antiretroviral protease inhibitor, at the standard dose (400/100 mg twice a day [BID]) with the antituberculous agent rifampin is contraindicated because of a significant pharmacokinetic interaction due to induction of cytochrome P450 3A by rifampin. In the present study, two adjusted-dose regimens of lopinavir-ritonavir were tested in combination with rifampin. Thirty-two healthy subjects participated in a randomized, two-arm, open-label, multiple-dose, within-subject controlled study. All subjects were treated with lopinavir-ritonavir at 400/100 mg BID from days 1 to 15. From days 16 to 24, the subjects in arm 1 received lopinavir-ritonavir at 800/200 mg BID in a dose titration, and the subjects in arm 2 received lopinavir-ritonavir at 400/400 mg BID in a dose titration. Rifampin was given at 600 mg once daily to all subjects from days 11 to 24. The multiple-dose pharmacokinetics of lopinavir, ritonavir, and rifampin were assessed. Twelve of 32 subjects withdrew from the study. For nine subjects lopinavir-ritonavir combined with rifampin resulted in liver enzyme level elevations. Pharmacokinetic data for 19 subjects were evaluable. Geometric mean ratios for the lopinavir minimum concentration in serum and the maximum concentration in serum (C(max)) on day 24 versus that on day 10 were 0.43 (90% confidence interval [CI], 0.19 to 0.96) and 1.02 (90% CI, 0.85 to 1.23), respectively, for arm 1 (n = 10) and 1.03 (90% CI, 0.68 to 1.56) and 0.93 (90% CI, 0.81 to 1.07), respectively, for arm 2 (n = 9). Ritonavir exposure increased from days 10 to 24 in both arms. The geometric mean C(max) of rifampin was 13.5 mg/liter (day 24) and was similar between the two arms. Adjusted-dose regimens of lopinavir-ritonavir in combination with therapeutic drug monitoring and monitoring of liver function may allow concomitant use of rifampin.
Collapse
Affiliation(s)
- C J L la Porte
- Department of Clinical Pharmacy, University Medical Centre Nijmegen, Nijmegen University Centre for Infectious Diseases, Nijmegen, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
113
|
Kim JH, Park JH. [A case of rifampicin associated Pseudomembranous colitis]. Korean J Gastroenterol 2004; 43:376-9. [PMID: 15220556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Pseudomembranous colitis is a dangerous but unusual side effect of antibiotics usage. We report a case of pseudomembranous colitis that developed in a 50-year-old female patient with diabetes mellitus during first line anti-tuberculous therapy including rifampicin. The patient was diagnosed with active pulmonary tuberculosis 70 days earlier. On admission, she suffered intermittent abdominal pain and watery diarrhea for 2 weeks. Colonoscopy revealed exudative, punctuate, raised plaques with skip areas or edematous hyperemic mucosa, and histopathologic findings were consistent with pseudomembranous colitis with typical volcano-like exudate. Symptoms improved on treatment with metronidazole. There was no recurrence after reinstitution of the anti-tuberculous agents excluding rifampicin. In patients with persistent diarrhea receiving anti-tuberculosis treatment, rifampicin associated pseudomembranous colitis should always be kept in mind.
Collapse
Affiliation(s)
- Jae Hi Kim
- Department of Internal Medicine, Pochon CHA University College of Medicine, Daegu, Korea.
| | | |
Collapse
|
114
|
Weiner M, Bock N, Peloquin CA, Burman WJ, Khan A, Vernon A, Zhao Z, Weis S, Sterling TR, Hayden K, Goldberg S. Pharmacokinetics of Rifapentine at 600, 900, and 1,200 mg during Once-Weekly Tuberculosis Therapy. Am J Respir Crit Care Med 2004; 169:1191-7. [PMID: 14962821 DOI: 10.1164/rccm.200311-1612oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The pharmacokinetics of rifapentine at 600, 900, and 1,200 mg were studied during once-weekly continuation phase therapy in 35 patients with tuberculosis. Mean area under the plasma concentration-time curve (AUC(0-infinity)) increased significantly with dose (rifapentine AUC(0- infinity): 296, 410, and 477 microg.hour/ml at 600, 900, and 1,200 mg, respectively; p = 0.02 by linear regression). In multivariate stepwise regression analyses, AUC(0-infinity) values for rifapentine and the active 25-desacetyl metabolite were associated with drug dose and plasma albumin concentration, and were lower among men and among white individuals. Fifty-four percent of patients had total (free and protein-bound) plasma concentrations of rifapentine and of desacetyl rifapentine detected for more than 36 hours after clearance of concurrently administered isoniazid. Serious adverse effects of therapy in these study patients were infrequent (1 of 35 cases; 3%) and not linked with higher rifapentine AUC(0-infinity) or peak concentration. The present pharmacokinetic study supports further trials to determine the optimal rifapentine dose for treatment of tuberculosis.
Collapse
Affiliation(s)
- Marc Weiner
- Department of Medicine, South Texas Veterans Health Care System, San Antonio, Texas 78229, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
115
|
Vega P, Sweetland A, Acha J, Castillo H, Guerra D, Smith Fawzi MC, Shin S. Psychiatric issues in the management of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2004; 8:749-59. [PMID: 15182146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Psychiatric issues present a challenge in the treatment of patients with multidrug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs and psychosocial factors require aggressive management. SETTING A community-based non-governmental health organization in Lima, Peru. OBJECTIVE To review the literature for psychiatric complications associated with anti-tuberculosis medications, to describe the incidence and prevalence of depression, anxiety and psychosis among individuals receiving MDR-TB therapy, and to detail the management approach used in this cohort. METHODS A retrospective case series was performed among the first 75 patients to receive individualized MDR-TB therapy in Lima, Peru, between 1996 and 1999. RESULTS Baseline depression and baseline anxiety were observed in respectively 52.2% and 8.7% of this cohort. Most individuals with baseline depression experienced improvement of depressive symptoms during the course of TB therapy. The incidence of depression, anxiety and psychosis during MDR-TB treatment was 13.3%, 12.0% and 12.0%, respectively. While the majority of individuals with depression, anxiety and psychosis required psychiatric pharmacotherapy, cycloserine was successfully continued in all but one case. CONCLUSION Psychiatric comorbidities are not a contra-indication to MDR-TB therapy. Management of psychiatric complications is possible without compromising anti-tuberculosis treatment.
Collapse
Affiliation(s)
- P Vega
- Neuropsychiatric Service, Department of Medicine, Ministry of Health, Lima, Peru
| | | | | | | | | | | | | |
Collapse
|
116
|
Abstract
Neutropenia is a rare complication of anti-tuberculous therapy and is usually due to a single agent, most frequently isoniazid. The current case describes a previously healthy immunocompetent patient with tuberculosis of the lymph nodes who developed neutropenia due to a number of first line antibiotics (rifampicin, isoniazid and ethambutol) and streptomycin when introduced in combination and individually thus resulting in repeated treatment disruption. The introduction of twice-weekly subcutaneous granulocyte-colony stimulating factor to correct iatrogenic neutropenia facilitated the continuation and eventual completion of therapy without adverse effect. This is the first description of the use of granulocyte-colony stimulating factor to correct iatrogenic neutropenia due to anti-tuberculous antibiotics and the second description of the occurrence of iatrogenic neutropenia to more than anti-tuberculous antibiotic in an individual.
Collapse
Affiliation(s)
- L J Cormican
- Dept of Respiratory Medicine, Second Floor, Thomas Guy House, Guy's Hospital, St. Thomas Street, London SE1 9RT, UK.
| | | | | |
Collapse
|
117
|
Bolton AE, Peng B, Hubert M, Krebs-Brown A, Capdeville R, Keller U, Seiberling M. Effect of rifampicin on the pharmacokinetics of imatinib mesylate (Gleevec, STI571) in healthy subjects. Cancer Chemother Pharmacol 2004; 53:102-6. [PMID: 14605865 DOI: 10.1007/s00280-003-0722-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2003] [Accepted: 09/18/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study was carried out to investigate the influence of CYP3A induction with rifampicin on imatinib (Gleevec) exposure. METHODS The study employed a single center, single-sequence design. A group of 14 healthy male and female subjects received imatinib as a single 400 mg oral dose on two occasions: on study day 1 and on study day 15. Rifampicin treatment (600 mg once daily) for CYP4503A induction was initiated on study day 8 and maintained until day 18. Imatinib pharmacokinetics were determined up to 96 h after dosing on day 1 (no induction) and on days 15-18 (during concomitant rifampicin). Plasma concentrations of imatinib and its main metabolite CGP74588 were determined using a LC/MS/MS method. The ratio of 6beta-hydroxycortisol to cortisol excreted in the urine was measured to monitor the induction of CYP3A. RESULTS During concomitant rifampicin administration, the mean imatinib C(max), AUC(0-24) and AUC(0- infinity ) decreased by 54% (90% CI: 48-60%), 68% (64-70%) and 74% (71-76%), respectively. The increase in clearance (Cl/f) was 385% (348-426%) during rifampicin treatment. The mean C(max) and AUC(0-24) of the metabolite CGP74588 increased by 88.6% (68.3%-111.4%) and 23.9% (13.5%-35.2%) after rifampicin pretreatment. However, the AUC(0- infinity ) decreased by 11.7% (3.3-19.4%). All subjects demonstrated a marked induction of hepatic microsomal CYP3A analyzed by the excretion ratio of 6beta-hydroxycortisol to cortisol from a mean baseline concentration of 5.6 U to 50.5 U. CONCLUSION Concomitant use of imatinib and rifampicin or other potent inducers of CYP4503A may result in subtherapeutic plasma concentrations of imatinib. In patients in whom rifampicin or other CYP3A inducers are prescribed, alternative therapeutic agents with less potential for enzyme induction should be selected.
Collapse
|
118
|
Abstract
BACKGROUND Two months of rifampin and pyrazinamide (RIF/PZA) for tuberculosis prevention has been advocated as a way to improve adherence in mobile populations, such as recent immigrants. However, RIF/PZA requires intensive patient and laboratory monitoring for hepatotoxicity. OBJECTIVES To describe the feasibility and outcomes of using RIF/PZA for TB prevention during a tuberculosis outbreak in a Mexican immigrant community, where 23 adults and 11 children were treated with RIF/PZA between August 2001 and October 2001. METHODS Retrospective chart review and interviews with health department employees were conducted to assess completion rates, hepatotoxicity, cost, and feasibility of monitoring. RESULTS Ten (91%) children and 13 (57%) adults completed RIF/PZA. One child (9%) and four adults (17%) developed drug-induced hepatitis. Cultural barriers affected care. The adults resisted the biweekly blood draw, believing it would "drain them of energy." RIF/PZA, plus monitoring, was twice as costly as 4 months of rifampin. CONCLUSIONS RIF/PZA was associated with significant hepatotoxicity, poor completion, and cultural barriers to monitoring, and was more costly than standard therapy. Tuberculosis prevention must address potential clinical, cultural, and economic barriers to completion and monitoring of short-course therapy in immigrants.
Collapse
Affiliation(s)
- Namratha R Kandula
- Robert Wood Johnson Clinical Scholars Program, University of Chicago, Chicago, Illinois 60637, USA.
| | | | | | | |
Collapse
|
119
|
Covic A, Golea O, Segall L, Meadipudi S, Munteanu L, Nicolicioiu M, Tudorache V, Covic M, Goldsmith DJA. A clinical description of rifampicin-induced acute renal failure in 170 consecutive cases. J Indian Med Assoc 2004; 102:20, 22-5. [PMID: 15195854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Rifampicin re-administration may cause immunologically mediated acute tubulo-interstitial injury. Retrospectively, 170 consecutive cases with acute renal failure (ARF) following re-treatment with rifampicin (71% males, 29% females, age 21 to 68 years) were analysed, which accounted for 12% of all ARF patients treated by two large dialysis referral centres in Romania, Timisoara and Iasi, between 1974-2001 and 1988-2001, respectively. The most frequent clinical features of rifampicin-induced ARF were: Anuria, gastro-intestinal (abdominal pain, nausea, vomiting and diarrhoea) and "flu-like" symptoms. Urine analysis revealed sterile leucocyturia in 54%, proteinuria in 31%, haematuria in 26% and haemoglobinuria in 7% of cases. Haemolytic anaemia was frequent, found in 66% of the patients; half of these had Hct values of < 30%, thrombocytopenia and also more severe renal damage (a longer anuric phase and a slower recovery of the renal function), thus suggesting a severe multi-target autoimmune aggression. The association of hepatic injury--not explained by prior hepatic disease, B or C hepatitis virus infection or history of alcohol abuse--was encountered in 17% of the cases, without a significant influence on the renal and the general outcome. The outcome of rifampicin-induced ARF is generally favourable, with complete recovery of the renal function within 30 days in 52% of the cases and within 90 days in 92% of the cases. The mortality rate was 3.5%, compared to 21% for the overall ARF population treated during the same period (p < 0.05).
Collapse
Affiliation(s)
- A Covic
- CI Parhon Hospital, Iasi, Romania
| | | | | | | | | | | | | | | | | |
Collapse
|
120
|
Abstract
OBJECTIVE To compare the steady-state plasma and intrapulmonary concentrations of oral rifampicin (rifampin) in men and women with and without AIDS. DESIGN Prospective nonblinded pharmacokinetic study. PARTICIPANTS Ten men with AIDS, ten men without AIDS, ten women with AIDS, and ten women without AIDS. METHODS Rifampicin 600 mg was administered orally once daily for 5 days to 40 adult volunteers. Blood was obtained 2 hours after the last dose and at the time of bronchoalveolar lavage (BAL) performed 4 hours after the last dose. Rifampicin was measured in plasma, epithelial lining fluid (ELF) and alveolar cells. Standardised BAL was performed without systemic sedation. The volume of ELF was calculated by the urea dilution method, and alveolar cells were recovered by a standardised centrifugation technique. The volume of alveolar cells was calculated from the cell count and differential performed on the BAL fluid. Rifampicin was measured by high-performance liquid chromatography. RESULTS Sex or AIDS status had no effect on plasma concentrations of rifampicin at 2 hours, 4 hours, or in ELF. Plasma concentrations (mean +/- SD) of rifampicin at 2 hours (9.15 +/- 5.4 mg/L) were not significantly different (p > 0.05) from those at 4 hours (9.10 +/- 5.6 mg/L) following the last dose. The ELF concentration was 2.0 +/- 1.6 mg/L with a range of 0-7.3 mg/L and the ELF/plasma ratio at 4 hours was 0.2 +/- 0.2. Rifampicin was not detectable in ELF in eight subjects (three with AIDS and five without AIDS) or in alveolar cells in three subjects without AIDS. There was no significant effect of AIDS on alveolar cell concentrations of rifampicin. Alveolar cell concentrations of rifampicin were significantly greater in women (13.9 +/- 6.7 mg/L) than in men (6.6 +/- 4.1 mg/L) [p = 0.0003]. Alveolar cell rifampicin concentrations were 78% greater in smoking women (17.8 +/- 7.0 mg/L) than in nonsmoking women (10.0 +/- 2.4 mg/L), but the difference was not significant (p > 0.05). CD4+ cell counts in the AIDS subjects were not correlated with the concentrations of rifampicin in plasma, ELF or alveolar cells. CONCLUSIONS The absorption of oral rifampicin was not affected by sex or AIDS. Plasma and alveolar cell concentrations were not significantly different, were both greater than ELF concentrations, and were adequate to inhibit Mycobacterium tuberculosis. Considerable interpatient variability was detected despite witnessed drug administration. The clinical significance of these findings is unknown but merits further investigation.
Collapse
Affiliation(s)
- John E Conte
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | | | | | | |
Collapse
|
121
|
Ashitani JI, Yanagi S, Arimura Y, Sano A, Mukae H. Acute Respiratory Distress Syndrome Induced by Rifampicin with High Levels of Neutrophil and Eosinophil Products in Bronchoalveolar Lavage Fluid. Respiration 2003; 70:541-3. [PMID: 14665784 DOI: 10.1159/000074216] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2002] [Accepted: 01/13/2003] [Indexed: 11/19/2022] Open
Abstract
We reported a case with acute respiratory distress syndrome (ARDS) caused by rifampicin during therapy for pulmonary tuberculosis. A high level of eosinophil cationic protein in bronchoalveolar lavage fluid (BALF) was detected as well as interleukin-8 and neutrophil elastase. Based on these results together with the positive result of the drug lymphocyte-stimulating test, we concluded that rifampicin was the causative drug leading to ARDS. Corticosteroid therapy resulted in clinical improvement and resolution of the pulmonary infiltrates on the chest radiograph without the recurrence of pulmonary tuberculosis.
Collapse
Affiliation(s)
- Jun-Ichi Ashitani
- Third Department of Internal Medicine, Miyazaki Medical College, Miyazaki, Japan.
| | | | | | | | | |
Collapse
|
122
|
Golpe R, Mateos A. Rifampicin induced pneumonitis or bronchogenic spread of tuberculous empyema through a bronchopleural fistula? Thorax 2003; 58:910; author reply 910. [PMID: 14514951 PMCID: PMC1746474 DOI: 10.1136/thorax.58.10.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
123
|
Fenniche S, Maalej S, Fekih L, Hassene H, Belhabib D, Megdiche ML. [Manifestations of rifampicin-induced hypersensitivity]. Presse Med 2003; 32:1167-9. [PMID: 13677879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION The side effects of rifampicine due to an immunoallergic mechanism are rare and usually observed during discontinued treatment or administration of high doses. OBSERVATIONS An immediate hypersensitivity reaction with anaphylactic manifestations and increase in IgE occurred in a 39 year-old man suffering from resistant tuberculosis. The reaction occurred within the first hour following a low dose of rifampicin administered in a desensitisation attempt, the outcome of which was favourable after administration of corticosteroids and antihistamines. A type II hypersensitivity reaction occurred in a 76 year-old male patient in the form of thrombopenia on D76 of a twice weekly treatment, diagnosed because of hemoptysis with normalisation of platelet level on withdrawal of rifampicin. An immune complex hypersensitivity reaction was responsible for hepato-renal failure on D68 of twice weekly treatment and required permanent withdrawal of rifampicin and dialysis, which led to subsequent improvement. COMMENTS These clinical cases illustrate the variability of the hypersensitivity mechanisms observed with rifampicin, the difficulty in imputability tests and methods for immunological confirmation, the interest of continuous treatment which avoids a certain number of these accidents, and that of desensitisation during immediate hypersensitive reactions which permits the continuation this major anti-tuberculosis drug.
Collapse
Affiliation(s)
- Soraya Fenniche
- Service Ibn Nafiss, Hôpital Abderrahmen Mami, Ariana 2080, Tunisie
| | | | | | | | | | | |
Collapse
|
124
|
Kunimoto D, Warman A, Beckon A, Doering D, Melenka L. Severe hepatotoxicity associated with rifampin-pyrazinamide preventative therapy requiring transplantation in an individual at low risk for hepatotoxicity. Clin Infect Dis 2003; 36:e158-61. [PMID: 12802781 DOI: 10.1086/375072] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2002] [Accepted: 01/22/2003] [Indexed: 11/03/2022] Open
Abstract
We report a case of severe hepatotoxicity associated with rifampin-pyrazinamide preventative therapy that required liver transplantation in a closely monitored, human immunodeficiency virus-uninfected individual who had no risk for hepatotoxicity. Because hepatotoxicity associated with this treatment appears to be idiosyncratic, we recommend closer monitoring of liver enzyme levels than do the Centers for Disease Control and Prevention guidelines, as well as at least temporary interruption of treatment during any elevation of liver enzyme levels greater than the normal value.
Collapse
Affiliation(s)
- D Kunimoto
- Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada, T6G 2B7.
| | | | | | | | | |
Collapse
|
125
|
|
126
|
Affiliation(s)
- J-H Kim
- Department of Pediatrics, College of Medicine, Ulsan University, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, 138-736 Seoul, Korea
| | | | | | | |
Collapse
|
127
|
Golchin B, McClellan K. Corneal endothelial deposits secondary to rifabutin prophylaxis for Mycobacterium avium complex bacteraemia. Br J Ophthalmol 2003; 87:798-9. [PMID: 12770995 PMCID: PMC1771698 DOI: 10.1136/bjo.87.6.798] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
128
|
|
129
|
Stout JE, Engemann JJ, Cheng AC, Fortenberry ER, Hamilton CD. Safety of 2 months of rifampin and pyrazinamide for treatment of latent tuberculosis. Am J Respir Crit Care Med 2003; 167:824-7. [PMID: 12446275 DOI: 10.1164/rccm.200209-998oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An alternative regimen for the treatment of latent tuberculosis infection is 2 months of rifampin and pyrazinamide, but some patients have died of hepatitis associated with this therapy. One hundred fourteen patients received rifampin/pyrazinamide in Wake County, North Carolina, between December 1999 and May 2002; 60.5% of these patients were homeless, and at least 17% drank alcohol to excess. Seventy-seven patients (67.5%) completed a full 2-month course. Nine patients had a history of viral hepatitis or chronic liver disease. Four of 114 (3.5%; 95% confidence interval, 1.0-8.7%) patients developed hepatitis on therapy, and another two had symptoms consistent with hepatitis but did not report for laboratory testing (total confirmed plus suspected hepatitis rate 5.3%; 95% confidence interval, 2.0-11.1%). No patient who developed hepatitis had a history of viral hepatitis or liver disease, and none had been previously treated with isoniazid. No patients died or were hospitalized due to drug side effects. Rifampin/pyrazinamide was associated with a significantly higher rate of hepatitis than previously described with isoniazid therapy for latent tuberculosis but resulted in a high completion rate. The rifampin/pyrazinamide regimen for latent tuberculosis infection may be useful for high-risk, traditionally nonadherent patient groups, but careful monitoring for toxicity is required.
Collapse
Affiliation(s)
- Jason E Stout
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA.
| | | | | | | | | |
Collapse
|
130
|
Tattevin P, Revest M, Dupont M, Arvieux C, Michelet C. A regimen containing rifabutin for the treatment of tuberculosis in patients intolerant to rifampin. Clin Infect Dis 2003; 36:127-8. [PMID: 12491218 DOI: 10.1086/345532] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
131
|
Lee AM, Mennone JZ, Jones RC, Paul WS. Risk factors for hepatotoxicity associated with rifampin and pyrazinamide for the treatment of latent tuberculosis infection: experience from three public health tuberculosis clinics. Int J Tuberc Lung Dis 2002; 6:995-1000. [PMID: 12475146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
SETTING Three municipal tuberculosis (TB) clinics. OBJECTIVES Reports of liver injury in patients treated with a 2-month regimen of daily rifampin and pyrazinamide (2RZ) for latent TB infection have raised concern about its safety. We aimed to evaluate the safety and tolerability of 2RZ and identify risk factors for hepatotoxicity. METHODS We reviewed charts of adults started on 2RZ between 1999 and 2001. Cases with grade 3 hepatotoxicity (AST or ALT >5.0-20.0 x upper limit of normal) and grade 4 hepatotoxicity (AST or ALT >20.0 x upper limit of normal) were identified. RESULTS Of 148 patients prescribed 2RZ, 85 (57.4%) completed therapy. Grade 3 or 4 hepatotoxicity occurred in 14 patients (eight grade 4 cases). In multivariate analysis, hepatotoxicity was associated with female sex (odds ratio [OR] 4.1; 95% confidence interval [CI] 1.2-14.3) and with presumed recent infection (recent tuberculin skin test conversion or contact with a TB case) (OR 14.3; 95%CI 1.8-115), but not with alcohol use, illicit drug use, age, race, or pyrazinamide dose. CONCLUSIONS Hepatotoxicity occurred in a high proportion of patients prescribed 2RZ, and was more common among females and those with recent infection. Caution is warranted in using 2RZ in populations where its safety has not been established.
Collapse
Affiliation(s)
- A M Lee
- Communicable Disease Program, Chicago Department of Public Health, Chicago, IL 60612, USA
| | | | | | | |
Collapse
|
132
|
Abstract
An 81-year-old man was admitted to hospital with pulmonary Mycobacterium tuberculosis infection and was treated with rifampicin (RFP), isoniazid (INH), and ethambutol (EB). On day 9 he developed fever and dyspnoea. Chest radiographs showed new infiltration shadows in the right lung. Bronchoalveolar lavage (BAL) was performed and increased numbers of lymphocytes were recovered. Drug induced pneumonitis was suspected so the antituberculous regimen was discontinued and methylprednisolone was administered. The symptoms and infiltration shadows improved. INH and EB were reintroduced without any recurrence of the abnormal shadows. T cell subsets in the BAL fluid and a positive lymphocyte stimulation test for RFP suggest that RFP induced pneumonitis may be related to a complex immunological response.
Collapse
Affiliation(s)
- N Kunichika
- Department of Internal Medicine, National Sanyo Hospital, Yamaguchi, Japan.
| | | | | | | | | | | |
Collapse
|
133
|
Jasmer RM, Saukkonen JJ, Blumberg HM, Daley CL, Bernardo J, Vittinghoff E, King MD, Kawamura LM, Hopewell PC. Short-course rifampin and pyrazinamide compared with isoniazid for latent tuberculosis infection: a multicenter clinical trial. Ann Intern Med 2002; 137:640-7. [PMID: 12379063 DOI: 10.7326/0003-4819-137-8-200210150-00007] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Rifampin and pyrazinamide are recommended for treatment of latent tuberculosis infection in adults without HIV infection, but reports of severe hepatotoxicity have raised concerns about its safety. Clinical trials have not compared this treatment with isoniazid in adults without HIV infection. OBJECTIVE To compare the safety and tolerance of a 2-month regimen of rifampin and pyrazinamide with that of a 6-month regimen of isoniazid for treatment of latent tuberculosis infection. DESIGN Multicenter, prospective, open-label trial. SETTING Three urban public health tuberculosis clinics in the United States. PATIENTS 589 adults with latent tuberculosis infection who met U.S. criteria for treatment. INTERVENTION Patients were assigned in alternate weeks to receive rifampin and pyrazinamide daily for 2 months (n = 307) or isoniazid daily for 6 months (n = 282). MEASUREMENTS Primary end points were hepatotoxicity, other adverse events, and percentage of patients who completed treatment. RESULTS Sixteen of 207 (7.7%) patients assigned to rifampin and pyrazinamide developed grade 3 or 4 hepatotoxicity compared with 2 of 204 (1%) patients assigned to isoniazid (odds ratio, 8.46 [95% CI, 1.9 to 76.5]; P = 0.001). The rifampin plus pyrazinamide regimen was more likely than the isoniazid regimen to be discontinued because of hepatotoxicity (odds ratio, 5.19; P = 0.033). The overall percentage of nonhepatotoxic adverse events was 20% in the rifampin-pyrazinamide group and 16% in the isoniazid group. The proportion of patients who completed the study treatment was 61% and 57%, respectively. CONCLUSIONS A 2-month regimen of rifampin and pyrazinamide was associated with an increased risk for grade 3 or 4 hepatotoxicity compared with a 6-month regimen of isoniazid. Liver enzymes should be measured routinely during treatment to screen for liver injury and prevent progression to severe toxicity.
Collapse
Affiliation(s)
- Robert M Jasmer
- San Francisco General Hospital Medical Center, University of California, San Francisco, California, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
134
|
|
135
|
Abstract
BACKGROUND Acute renal failure (ARF) caused by rifampicin typically occurs on intermittent administration. There are isolated case reports and only one series reported in the literature. Systematic data, especially from countries endemic for tuberculosis and leprosy, are sparse. METHODS We studied demographic, clinical, biochemical, and histopathologic features and prognosis of 25 consecutive patients with rifampicin-associated ARF admitted from July 1990 to June 2000. RESULTS Rifampicin-associated ARF constituted 2.5% of all cases of ARF seen during the study period. The most common pattern of drug intake resulting in ARF (40%) was ingestion of a single dose preceded by a drug-free period (range, 10 days to 6 years) after a course of daily rifampicin (range, 8 days to 18 months). Onset was with gastrointestinal and flu-like symptoms 4 hours (median) after drug intake. All patients were oliguric. Anemia and thrombocytopenia each occurred in 60% of patients. Acute hepatitis was present in 32%. Among 12 patients who underwent kidney biopsy, 7 patients (58%) had acute interstitial nephritis (AIN). Crescentic glomerulonephritis was seen in 1 patient, and mesangial proliferation, in 3 patients. No single feature at presentation predicted the severity of renal failure. There were no deaths, and all patients recovered renal function. CONCLUSION Patients with rifampicin-associated ARF were oliguric and presented with gastrointestinal and flu-like symptoms, typically after reintroduction of the drug after a drug-free period. Anemia and thrombocytopenia were common. AIN was the most common biopsy finding. No factor predicted severity, but the renal prognosis was good.
Collapse
Affiliation(s)
- Thangamani Muthukumar
- Department of Nephrology, Madras Medical College and Government Hospital, Chennai, India
| | | | | | | |
Collapse
|
136
|
Ponjavic V, Gränse L, Bengtsson Stigmar E, Andréasson S. Retinal dysfunction and anterior segment deposits in a patient treated with rifabutin. Acta Ophthalmol Scand 2002; 80:553-6. [PMID: 12390172 DOI: 10.1034/j.1600-0420.2002.800519.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To describe the clinical and electrophysiological findings in a young boy with decreased vision possibly due to retinal damage by rifabutin. METHODS An 8-year-old boy with osteomyelitis was referred due to visual disturbance. During a period of 4 years, the boy was examined six times with electroretinography. Ophthalmological examination included testing of visual acuity, slit-lamp inspection, fundus inspection, fundus photography and kinetic perimetry. Two electrophysiological methods were performed for objective evaluation of retinal function, namely full-field electroretinography and multifocal electroretinography. RESULTS We found a slightly reduced visual acuity, a slowly increasing amount of yellow-white deposits on the posterior surface of the cornea and on the anterior part of the lens, a normal fundus appearance, and normal visual fields. However, the electroretinogram was abnormal on several occasions during therapy with rifabutin, but returned to normal 3 months after withdrawal of the medication. The multifocal electroretinogram returned to normal after the full-field electroretinogram had done so. The anterior chamber deposits still remain. CONCLUSION Long-term treatment with rifabutin may have a reversible and previously undescribed side-effect on retinal function. The drug may also accumulate irreversibly on the posterior surface of the cornea and on the anterior surface of the lens. We suggest that objective evaluation of retinal function with electrophysiological methods should be performed in patients with visual disturbance during treatment with rifabutin.
Collapse
Affiliation(s)
- V Ponjavic
- Department of Ophthalmology, University of Lund, Sweden.
| | | | | | | |
Collapse
|
137
|
Jones DF, Irwin AE. Discoloration of intraocular lens subsequent to rifabutin use. Arch Ophthalmol 2002; 120:1211-2. [PMID: 12215098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Daniel Fuller Jones
- Division of Ophthalmology, Fletcher Allen Health Care, UHC Fourth Floor, Burlington, VT 05405
| | | |
Collapse
|
138
|
|
139
|
Abstract
We report three patients who developed haemolysis following rifampicin treatment. Initially, autoimmune haemolytic anaemia (AIHA) of the warm type and/or an acute haemolytic transfusion reaction (AHTR) was suggested. The direct antiglobulin tests (DAT) were strongly positive for IgG and C3d, and tests for rifampicin-dependent antibodies were positive in all three cases, featuring C-specificity in one case. The outcome was fatal in two out of the three cases, presumably due to belated diagnosis. This shows that rifampicin may stimulate the production of autoantibodies (aab) and/or drug-dependent antibodies (ddab), and that the resulting haemolytic syndrome bears similarities with AIHA and AHTR.
Collapse
Affiliation(s)
- Norbert Ahrens
- Institute of Transfusion Medicine, Campus Virchow-Klinikum, University Hospital Charité, Humboldt-University, Augustenburger Platz 1, 13353 Berlin, Germany.
| | | | | |
Collapse
|
140
|
Abstract
We present the case of an elderly patient who died of fulminant hepatic failure in the course of receiving 2 months of treatment with pyrazinamide and rifampin for his latent tuberculosis. This 2-month course of treatment for latent tuberculosis is one of four options recently recommended by the Centers for Disease Control and Prevention. We discuss the safety of using this two-drug regimen to treat latent tuberculosis in stable elderly patients.
Collapse
Affiliation(s)
- Ann Medinger
- Department of Veterans Affairs Medical Center, Washington, DC, USA.
| |
Collapse
|
141
|
Fernandes GCTS, Vieira MAMS, Lourenço MC, Gadelha AJ, Coura LC, Rolla VC. Inflammatory paradoxical reaction occurring in tuberculosis patients treated with HAART and rifampicin. Rev Inst Med Trop Sao Paulo 2002; 44:113-4. [PMID: 12048550 DOI: 10.1590/s0036-46652002000200011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
142
|
Swanton AG, Paterson-Brown S. Secondary amenorrhoea due to the use of rifampicin as an antimycobacterial agent. J OBSTET GYNAECOL 2002; 22:227-8. [PMID: 12528712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- A G Swanton
- Queen Charlottes and Chelsea Hospital, Ducane Road, London W12 0NN, UK
| | | |
Collapse
|
143
|
Abstract
A 10-year-old girl with chronic myelogenous leukemia began receiving cyclosporine the day before bone marrow transplant surgery Three days after the transplant, she developed fever and neutropenia due to a Staphylococcus aureus bacteremia. Despite treatment with various antibiotics, the patient's fever persisted over the next 4 days. Intravenous rifampin was added to her antibiotic regimen of piperacillin, tobramycin, cloxacillin, and amphotericin. On day 12, the patient's blood cultures were negative and her fever had resolved; rifampin was discontinued. On day 16, the patient engrafted; she subsequently developed a grade II graft-versus-host disease of the skin and gastrointestinal tract, which responded to methylprednisolone. Her cyclosporine blood levels, which had been subtherapeutic since day 5 despite increasing intravenous dosages, were within the therapeutic range on day 21, and she was discharged 12 days later. To our knowledge, this is the first documented case of an intravenous cyclosporine-rifampin interaction that resulted in subtherapeutic cyclosporine concentrations in a child receiving a bone marrow transplant who subsequently developed acute graft-versus-host disease.
Collapse
Affiliation(s)
- Elyse J Zelunka
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| |
Collapse
|
144
|
Fineman MS, Vander J, Regillo CD, Fineman SW, Brown GC. Hypopyon uveitis in immunocompetent patients treated for Mycobacterium avium complex pulmonary infection with rifabutin. Retina 2002; 21:531-3. [PMID: 11642387 DOI: 10.1097/00006982-200110000-00020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M S Fineman
- Retina Vitreous Consultants, Pittsburgh, Pennsylvania 15213, USA
| | | | | | | | | |
Collapse
|
145
|
Abstract
A 60-year-old man was treated with rifampicin, isoniazid, ethambutol and pyrazinamide for pulmonary tuberculosis. Acute renal failure developed 1 month after re-administration of rifampicin following 1 month's interruption of treatment. A renal biopsy showed crescentic lesions characteristic of rapidly progressive glomerulonephritis. This is, to our knowledge, the fourth case of rapidly progressive crescentic glomerulonephritis associated with rifampicin treatment, which responded to methylprednisolone pulse therapy followed by oral steroid therapy.
Collapse
Affiliation(s)
- Keiji Yoshioka
- First Department of Internal Medicine, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan
| | | | | | | | | |
Collapse
|
146
|
Munteanu L, Golea O, Nicolicioiu M, Tudorache V. [Specific features of acute renal failure in patients treated with rifampicin]. Pneumologia 2002; 51:15-20. [PMID: 12043271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
This retrospective study was performed on 92 patients diagnosed with acute renal failure (ARF) post discontinuous rifampicin treatment, admitted between 1974-2000, in Hemodialysis Center of 1st Timisoara Clinical County Hospital. The passage from the continuous treatment (7/7) to discontinuous RMP treatment triggered the ARF in 77 patients and the restart of the treatment after one year or more of treatment arrest, lead to ARF in 15 cases. The ARF symptomatology appeared in the first 12 hrs of treatment resumption in 14.13% cases and in 85.87% after 38.5 +/- 8.2 hrs. The most frequent symptoms were lumbar pain in 76.08%, nausea and vomiting in 60.86%, abdominal pain (52.17% of cases) flu-like (fever, chills, myalgia), jaundice, diarrhea, hypotension, confusion and hypertension in only 7.6% of cases. In 94.56% of cases renal symptoms appeared in normal kidneys. The renal injury evolution was favorable, with significant improvements after 20 days in serum and urine biological parameters. The antibodies anti-RMP were present in serum 55.43% of patients, in 80.39% of them, the presence of antibodies was related to high values of gamma-globulins. In 33.69% of patients sterile leukocyturia, considered a marker of interstitial nephritis, was present. The most frequent associated ARF complications were the hemolytic anemia emphasized by high levels of unconjugated bilirubin and positive Coombs' test in 93.3% of patients, and liver injuries, present in 41.69% of cases. Thrombocytopenia was registered in 27.7% of cases, infections in 28.6%, gastrointestinal complications in 11.95%, and cardiovascular complications in 9.78% of cases, these severe forms leading to the death of patients. The ARF post discontinuous rifampicin treatment presents a favorable evolution even when it is associated with other organ or systems complications. The ARF and associated complications are due to the specific immune system activation by rifampicin, and by direct toxic effects of rifampicin at tissues level.
Collapse
|
147
|
Abstract
BACKGROUND Evidence supports a role for the NMDA receptors in learning and memory. These can be modulated by the antibiotic D-cycloserine in such a way that the effect of the excitatory transmitter substance glutamate is enhanced. A study on healthy subjects pretreated with scopolamine to mimic Alzheimer's disease showed a positive effect of D-cycloserine at low doses. OBJECTIVES To assess the efficacy and safety of D-cycloserine in patients with Alzheimer's disease. SEARCH STRATEGY The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 14 June 2001 using the terms: cycloserine, D-cycloserine, Alzheimer*. SELECTION CRITERIA Randomized, double-blinded and unconfounded trials comparing D-cycloserine with a control treatment. DATA COLLECTION AND ANALYSIS Two larger and two smaller randomized controlled trials were identified. The clinical global impression scale was used in all studies and was a primary outcome measure. MAIN RESULTS It was not possible to extract the results from the first phases of the two crossover studies and therefore the meta-analyses are based on the two parallel group 6-month studies. There was no indication of a positive effect favouring D-cycloserine for the numbers showing improvement at 6 months as assessed by the Clinical Global Impression for any dose. The number of withdrawals for any reason before end of treatment at 6 months was significantly in favour of placebo (fewer withdrawals) compared with D-cycloserine for dose levels of 30 mg/day (OR 2.94, 95% CI 1.52, 5.70) and 100 mg/day (OR 3.23, 95% CI 1.67, 6.25). There was no significant difference between treatment, (2, 10, 30, 100, or 200 mg/day) and placebo for the number of withdrawals due to adverse events by six months. REVIEWER'S CONCLUSIONS The lack of a positive effect of D-cycloserine on cognitive outcomes in controlled clinical trials with statistical power high enough to detect a clinically meaningful effect means that D-cycloserine has no place in the treatment of patients with Alzheimer's disease.
Collapse
Affiliation(s)
- K Laake
- Department of Geriatric Medicine, Ullevaal Hospital, Kirkevn. 166, Oslo, Norway.
| | | |
Collapse
|
148
|
Shinoda C, Hayashi R, Kawasaki A, Maruyama M, Kobayashi M. [A case of polymyositis complicated with pulmonary tuberculosis concerned with steroid resistance due to rifampin administration]. Nihon Kokyuki Gakkai Zasshi 2001; 39:955-60. [PMID: 11875815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A 63-year-old woman in whom polymyositis had been diagnosed since 1994 was treated with ten mg of prednisolone. In 1998, she contracted pulmonary tuberculosis simultaneously with acute exacerbation of the polymyositis. The polymyositis was then treated with 40 mg of prednisolone, and the pulmonary tuberculosis, with isoniazid (INH), rifampin (RFP) and ethambutol (EB). However, the polymyositis was worsening, possibly because the administration of RFP had induced steroid resistance. Because of this, a large amount of steroid was considered necessary for the treatment of the polymyositis (PSL 80 mg/day). An additional administration of cyclosporine (CyA) made possible a decrease in the amount of steroid given. RFP has a potency to induce the enzyme p450, which has the effect of metabolizing steroids or CyA, thus shortening the half-life of these agents. When a case of polymyositis is superimposed with pulmonary tuberculosis, it should be remembered that RFP may shorten the half-life of any steroid or CyA that is administered as treatment.
Collapse
Affiliation(s)
- C Shinoda
- Internal Medicine, Saiseikai Takaoka Hospital, Toyama, 933-8525, Japan
| | | | | | | | | |
Collapse
|
149
|
Ribera E, Pou L, Fernandez-Sola A, Campos F, Lopez RM, Ocaña I, Ruiz I, Pahissa A. Rifampin reduces concentrations of trimethoprim and sulfamethoxazole in serum in human immunodeficiency virus-infected patients. Antimicrob Agents Chemother 2001; 45:3238-41. [PMID: 11600390 PMCID: PMC90816 DOI: 10.1128/aac.45.11.3238-3241.2001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2000] [Accepted: 08/12/2001] [Indexed: 11/20/2022] Open
Abstract
To determine whether rifampin reduces concentrations of trimethoprim (TMP) and sulfamethoxazole (SMX) in serum of human immunodeficiency virus (HIV)-infected persons, levels of these agents were determined by high-performance liquid chromatography before and after more than 12 days of standard antituberculosis treatment for 10 patients who had been taking one double-strength tablet of co-trimoxazole once daily for more than 1 month. Statistically significant, 47 and 23% decreases in TMP and SMX mean areas under the concentration-time curve from 0 to 24 h (AUC(0-24)), respectively, were observed after administration of rifampin. N-Acetyl-SMX profiles without and with rifampin were similar. The steady-state AUC(0-24) metabolite/parent drug ratio increased by 32% with rifampin administration. Our study shows that rifampin reduces profiles of TMP and SMX in serum of HIV-infected patients.
Collapse
Affiliation(s)
- E Ribera
- Infectious Disease Service, Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
150
|
Tsai TL, Lee CH, Chuang FR, Hsu KT. Acute renal failure caused by rifampicin re-exposure with 10-year of interval. Chang Gung Med J 2001; 24:729-33. [PMID: 11820654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A 53-year-old woman was treated for recurrent pulmonary tuberculosis with reintroduction of rifampicin after a medication-free interval of 10 years. After taking the first dose, she developed severe hemolytic anemia and oliguric acute renal failure and required temporary hemodialysis. The fulminant clinical course was compatible with rifampicin-induced acute renal failure. The renal function of this patient completely recovered after discontinuation of rifampicin and temporary hemodialysis. Since renal biopsy and anti-rifampicin antibodies cannot offer a definite diagnosis of rifampicin-induced acute renal failure, we must emphasize the importance of a clinical diagnosis of rifampicin-induced acute renal failure and complete history taking. Re-exposure is a critical factor. In this case, the rifampicin-free interval was as long as 10 years. Because of the feasible prognosis, reintroduction of rifampicin for recurrent pulmonary tuberculosis should not be abandoned, but the infrequent and life-threatening side effects should be kept in mind.
Collapse
Affiliation(s)
- T L Tsai
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
| | | | | | | |
Collapse
|