From the Guidelines
Rifampin is indicated as part of combination therapy for prosthetic valve endocarditis caused by Staphylococcus aureus, with a typical dosage of 900-1200 mg i.v. or orally in 2 or 3 divided doses, usually in combination with other antibiotics such as vancomycin and gentamicin. The treatment duration is typically 6 weeks for prosthetic valve infections 1. Rifampin should never be used as monotherapy due to the rapid development of resistance. It's particularly valuable for prosthetic valve infections because it penetrates biofilms that form on prosthetic materials and can reach bacteria within these protective structures.
Key Points
- Rifampin is used in combination with other antibiotics for prosthetic valve endocarditis caused by Staphylococcus aureus
- The typical dosage is 900-1200 mg i.v. or orally in 2 or 3 divided doses
- Treatment duration is typically 6 weeks for prosthetic valve infections
- Rifampin should not be used as monotherapy due to the risk of resistance
- It is particularly useful for prosthetic valve infections due to its ability to penetrate biofilms and reach bacteria within these structures
Important Considerations
- Clinicians should monitor for hepatotoxicity, drug interactions, and potential side effects including orange discoloration of body fluids when using rifampin 1
- Rifampin increases the hepatic metabolism of warfarin and other drugs, and its use requires careful consideration of potential drug interactions 1
- The clinical benefit of gentamicin addition has not been formally demonstrated, but it remains recommended for prosthetic valve endocarditis (PVE) 1
From the Research
Indications for Rifampin in Infective Endocarditis
The indications for rifampin in infective endocarditis are as follows:
- For native valve endocarditis caused by methicillin-resistant Staphylococcus aureus, rifampin may be added to vancomycin therapy 2
- For prosthetic valve endocarditis, a three-drug regimen including rifampin is generally recommended 2, 3
- For uncomplicated right-sided Staphylococcus aureus endocarditis in intravenous drug users, oral ciprofloxacin in combination with rifampin may be considered as an alternative to conventional intravenous antibiotic therapy 4
Specific Patient Populations
The use of rifampin in specific patient populations is as follows:
- In patients with surgically treated staphylococcal infective endocarditis, there is insufficient evidence to support the use of rifampin as adjunctive therapy 5
- In patients with native valve Staphylococcus aureus endocarditis, the addition of rifampin to standard therapy may be associated with increased risk of hepatotoxicity, drug-drug interactions, and emergence of resistant S. aureus isolates 6
Treatment Duration and Regimens
The treatment duration and regimens for rifampin in infective endocarditis are as follows: