Difference between revisions of "Rifampin"

(General)
(Editing, dosing information for adults, hyperlinks)
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==Adult Dosing==
 
==Adult Dosing==
*Active TB: 10mg/kg/day (in combination with isoniazid and pyrazinamide) PO or IV for 2 months; MAX, 600mg/day; then 10mg/kg/day (in combination with isoniazid) for 4 months or longer as needed
+
===Active TB===
*Inactive TB, HIV+: 600mg PO daily for 4 months
+
*10mg/kg/day (in combination with [[isoniazid]] and [[pyrazinamide]]) PO or IV for 2 months
*Meningitis: 600mg IV once daily (with vanc/cephalosporin)
+
**Then 10mg/kg/day (in combination with [[isoniazid]]) for 4 months or longer as needed
*Bartonellosis: 300mg PO or IV q12h plus doxycycline
+
**MAX, 600mg/day
*Brucellosis: 15-20mg/kg/day PO/IV in 1 or 2 divided doses for at least 6 weeks in combination with a tetracycline; MAX 600 to 900mg/day
+
===Inactive TB, HIV+===
*Infective endocarditis: 300mg IV or PO every 8 hours for a minimum of 6 weeks, in combination with appropriate antimicrobial therapy
+
*600mg PO daily for 4 months
 
+
===Meningitis===
 +
*600mg IV once daily (with [[vancomycin]]/[[cephalosporin]])
 +
===Bartonellosis===
 +
*300mg PO or IV q12h plus [[doxycycline]]
 +
===Brucellosis===
 +
*15-20mg/kg/day PO/IV in 1 or 2 divided doses for at least 6 weeks in combination with a [[tetracycline]]
 +
**MAX 600 to 900mg/day
 +
===Infective endocarditis===
 +
*300mg IV or PO every 8 hours for a minimum of 6 weeks, in combination with appropriate antimicrobial therapy
 +
===Hansen Disease===
 +
*Paucibacillary, single lesion
 +
**600 mg PO x1 with [[oflaxacin]] and [[minocycline]]
 +
*Paucibacillary
 +
**600 mg PO qmo x 6mo with [[dapsone]]
 +
*Multibacillary
 +
**600 mg PO qmo x 12mo w/ [[dapsone]] and [[clofazimine]]
 
==Pediatric Dosing==
 
==Pediatric Dosing==
  
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==Contraindications==
 
==Contraindications==
 
*Allergy to class/drug
 
*Allergy to class/drug
*concomitant use with atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, rilpivirine or elvitegravir/cobicistat
+
*Concomitant use with atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, rilpivirine or elvitegravir/cobicistat
  
 
==Adverse Reactions==
 
==Adverse Reactions==
 
===Serious===
 
===Serious===
*Agranulocytosis
+
*[[Agranulocytosis]]
*DIC
+
*[[DIC]]
 
*Hepatotoxicity
 
*Hepatotoxicity
 
*Nephrotoxicity
 
*Nephrotoxicity
 
===Common===
 
===Common===
*nausea/vomiting/diarrhea
+
*[[Nausea]]/[[vomiting]]
*headache, dizziness, fatigue, disequilibrium, weakness
+
*[[Diarrhea]]
*pruritus, flushing
+
*[[Headache]]
*turns your excretions orange!
+
*[[Dizziness]]
 +
*[[Fatigue]]
 +
*Disequilibrium
 +
*Weakness
 +
*[[Pruritus]]
 +
*Flushing
 +
*Turns your excretions orange!
  
 
==Pharmacology==
 
==Pharmacology==

Revision as of 06:50, 23 August 2017

General

  • Type: bactericidal antibiotic
  • Dosage Forms: 150, 300; PO, IV
  • Common Trade Names: Rifadin

Adult Dosing

Active TB

  • 10mg/kg/day (in combination with isoniazid and pyrazinamide) PO or IV for 2 months
    • Then 10mg/kg/day (in combination with isoniazid) for 4 months or longer as needed
    • MAX, 600mg/day

Inactive TB, HIV+

  • 600mg PO daily for 4 months

Meningitis

Bartonellosis

Brucellosis

  • 15-20mg/kg/day PO/IV in 1 or 2 divided doses for at least 6 weeks in combination with a tetracycline
    • MAX 600 to 900mg/day

Infective endocarditis

  • 300mg IV or PO every 8 hours for a minimum of 6 weeks, in combination with appropriate antimicrobial therapy

Hansen Disease

Pediatric Dosing

Special Populations

  • Pregnancy Rating: C
  • Lactation: Infant risk minimal
  • Renal Dosing:
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug
  • Concomitant use with atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, rilpivirine or elvitegravir/cobicistat

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 3-5hr
  • Metabolism: hepatic
  • Excretion:
  • Mechanism of Action: inhibits bacterial RNA synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis I
Enterococcus faecium R
MSSA S
MRSA S
CA-MRSA S
Staph. Epidermidis S
C. jeikeium S
L. monocytogenes S
Gram Negatives N. gonorrhoeae X2
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli R
Klebsiella sp R
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ I
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp X1
Serratia marcescens R
Salmonella sp R
Shigella sp R
Proteus mirabilis X1
Proteus vulgaris R
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia X1
Yersinia enterocolitica X1
Francisella tularensis S
Brucella sp. S+'
Legionella sp. X1
Pasteurella multocida X1
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp X2
Mycoplasm pneumoniae X1
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces X1
Bacteroides fragilis X1
Prevotella melaninogenica X1
Clostridium difficile X1
Clostridium (not difficile) X1
Fusobacterium necrophorum X1
Peptostreptococcus sp. X1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

Source

  1. Sanford Guide to Antimicrobial Therapy 2014