Rifampin


- Discussion:
    - for primary TB, treatment of assymptomatic carriers of N. meningitidis to eliminate meningococci from the nasopharynx;
    - also used in combination with other agents (cipro, levofloxacin, zyvox) for treatment of staphyloccocus infections;
    - it inhibits bacterial DNA dependent RNA polymerase activity;
    - may be especially useful to eradicate intracellar staph;
            - reference:
                   - Antibiotic-induced persistence of cytotoxic Staphylococcus aureus in non-phagocytic cells.

    - adult dosing:
            - pulmonary TB: 600mg PO qd;
            - for meningococcal carriers: 600mg PO qd;
    - note that rifampin should be administered 1hr before, or 2hr after a meal;
    - peds: meningococcus prophylaxis: 10 mg/kg/day qd x 3 days;
    - supplied: tab 300 mg;

    - rifampin w/ cipro / levaquin:
            - references: 
                   - Two-stage treatment of staphylococcal implant infections using vanc PMMA spacer and rifampin containing antibiotic.
                   - Efficacy of linezolid alone and in combination with rifampin in staphylococcal experimental foreign-body infection.
                   - Bactericidal activity of the combination of levofloxacin with rifampin in experimental prosthetic knee infection in rabbits due to methicillin-susceptible Staphylococcus aureus.
                   - Antagonistic effect of rifampin on efficacy of high-dose levofloxacin in staph experimental foreign-body infection.
                   - Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group.
                   - Levofloxacin plus rifampicin conservative treatment of 25 early staphylococcal infections of osteosynthetic devices for rigid internal fixation.
                   - Effectiveness of ciprofloxacin or linezolid in combination with rifampicin against Enterococcus faecalis in biofilms

- Cautions:
    - contraindicated with a h/o of hypersensitivity to rifampin;
    - use with caution in patients taking coumadin (incr requirments), liver dz,
    - note that staph resistance commonly occurs when used a monotherapy;
    - use w/ caution with isoniazid (increased hepatotoxicty);
    - note: diffusion from blood into CSF adequate w/ or w/o Inflammation;
    - dosing regimens for patients with renal insufficiency: (for 70 kg Adult)
            - gm/dosing interval in hours: CrCl: >80:0.3-0.6/24;  50-79:0.3-0.6/24; 30-49: 0.3-0.6/24;   10-29: 0.3-0.6/24;
            - 6-30% of drug will be excreted in to urine (w/ nl RF(x))



Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. Efficacy of antibiotic prophylaxis.

Efficacy of daptomycin in implant-associated infection due to methicillin-resistant Staphylococcus aureus: importance of combination with rifampin.

Linezolid alone or combined with rifampin against methicillin-resistant Staphylococcus aureus in experimental foreign-body infection.

Impact of biofilm on the in vitro activity of vancomycin alone and in combination with tigecycline and rifampicin against Staphylococcus aureus.

Oral step-down therapy is comparable to intravenous therapy for Staphylococcus aureus osteomyelitis.

The bactericidal effects of anti-MRSA agents with rifampicin and sulfamethoxazole-trimethoprim against intracellular phagocytized MRSA.

Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid.

Oral treatment of Staphylococcus spp. infected orthopaedic implants with fusidic acid or ofloxacin in combination with rifampicin.

Multiple combination bactericidal testing of staphylococcal biofilms from implant-associated infections.

Infection and musculoskeletal conditions: Prosthetic-joint-associated infections.

Effect of antibacterials on biofilms.

Reconsideration of Rifampin: A Unique Drug for a Unique Infection

Penetration of Rifampin through Staphylococcus epidermidis Biofilms



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, May 1, 2017 6:05 am