Infectious Disease Compendium

Rifampin

Dosing

CrCl Formula

CrCl > 80: 300 - 600 mg po/iv q 12 - 24 h. 300 tid for prosthetic valve endocarditis.

CrCl 80-50: 300 - 600 mg po/iv q 12 - 24 h.,

CrCl 50-10: 300 - 600 mg po/iv q 12 - 24 h.

CrCl < 10: 300 - 600 mg po/iv q 12 - 24 h.

Hemodialysis:

Peritoneal dialysis:

Obese diabetics may need an increased dose for the treatment of Tb (PubMed).

Important side effects

Turns the urine red. There is a story that a women was put on a medicine that turned the urine red and she wasn't told. It was only discovered when she peed in the pool of a neighbor and she sued her doctor for embarrassment and won. Apocryphal? Probably. But its too good a story to ruin with the facts.

Also anorexia, nausea, discoloration of urine, sweat, tears, saliva, elevated lfts, flu-like syndrome, heartburn, hepatotoxicity, thrombocytopenia (high-dose).

Intermittant dosing is associated with DIC.

Important drug interactions

Really kicks in the p450 system, good drug to eat up birth control pills and coumadin among others. acetyldigoxin, amiodarone, amprenavir, anisindione, aprepitant, atazanavir, atovaquone, betamethasone, bexarotene, bunazosin, buspirone, carbamazepine, carvedilol, caspofungin, chloramphenicol, chlorpropamide, clofibrate, clozapine, cortisone, cyclosporine, dapsone, delavirdine, deslanoside, dexamethasone, diazepam, dicumarol, digitoxin, digoxin, diltiazem, disopyramide, doxycycline, efavirenz, enalapril maleate, enalaprilat, entacapone, erlotinib, eszopiclone, ethinyl estradiol, ethionamide, fentanyl, fluconazole, fludrocortisone, fosamprenavir, fosphenytoin, gefitinib, gliclazide, glyburide, haloperidol, hydrocortisone, imatinib, indinavir, irinotecan, isoniazid, isradipine, itraconazole, ketoconazole, leflunomide, levomethadyl, levonorgestrel, levothyroxine, lorcainide, losartan, medroxyprogesterone, mefloquine, mestranol, methadone, methylprednisolone, metildigoxin, metoprolol, mexiletine, midazolam, morphine, nelfinavir, nevirapine, nifedipine, nisoldipine, norelgestromin, norethindrone, norgestrel, phenprocoumon, phenytoin, pirmenol, prednisolone, prednisone, propafenone, propranolol, pyrazinamide, quetiapine, quinidine, quinine, repaglinide, risperidone, ritonavir, rofecoxib, rosiglitazone, saquinavir, sertraline, simvastatin, sirolimus, tacrolimus, tamoxifen, telithromycin, terbinafine, theophylline, tocainide, tolbutamide, triamcinolone, triazolam, trimetrexate, valproic acid, verapamil, voriconazole, warfarin, zaleplon, zidovudine, zolpidem.

Rants and Screeds

Never, ever, ever, never use it as a single agent against anything, unless, of course, you want instant resistance to rifampin.

Pearls

Treatment of choice

Used for Mycobacterium Tb and non-Tb.

Use for

Synergy for Staphylococcus aureus especially when associated with infected hardware (prosthetic joints and valves). Did I mention never to use it alone? Also Acanthamoeba meningoencephalitis, Anthrax, Brucella, csf shunt infections, Ehrlichia, Haemophilus influenzae prophylaxis, Legionella pneumophila, Leishmania - cutaneous, Leprosy, meningitis/ventriculitis, Neisseria meningitidis prophylaxis, osteomyelitis, peritoneal dialysis infections, staphylococcal infections, streptococcal Pharyngitis.

Don't use for

Monotherapy.

Class