From the Guidelines
Rifampin is primarily used to treat tuberculosis (TB) as part of a multi-drug regimen, and for latent TB infection, it can be given as monotherapy for 4 months as an alternative to isoniazid, as recommended by the most recent guidelines 1. The standard treatment duration for active TB disease is 6 months, with rifampin usually dosed at 600mg daily for adults.
- Rifampin is also used to treat leprosy, serious Staphylococcal infections including MRSA, Legionnaires' disease, and for prophylaxis against meningococcal meningitis in close contacts of infected individuals.
- Additionally, it's used for eliminating Neisseria meningitidis carriage in asymptomatic carriers. Rifampin works by inhibiting bacterial RNA polymerase, preventing RNA synthesis and ultimately killing the bacteria.
- Important considerations when taking rifampin include its interaction with many medications through cytochrome P450 enzyme induction,
- its characteristic side effect of turning body fluids orange-red,
- and the need to take it on an empty stomach for optimal absorption. Patients should be monitored for hepatotoxicity, especially when combined with other potentially hepatotoxic drugs, as noted in previous studies 1. The most recent guidelines recommend a regimen of 4 months of daily rifampin as a preferred treatment for HIV-negative adults and children of all ages 1. This regimen has been shown to be clinically equivalent to, and less toxic than, the standard regimen of 9 months of daily isoniazid in adults and children. It's essential to consider the potential interactions between rifampin and antiretroviral agents, as well as the need for individualized treatment decisions in patients with HIV infection and tuberculosis 1.
From the FDA Drug Label
In the treatment of both tuberculosis and the meningococcal carrier state, the small number of resistant cells present within large populations of susceptible cells can rapidly become the predominant type Rifampin is indicated in the treatment of all forms of tuberculosis. Rifampin is indicated for the treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx
The uses of Rifampin are:
- Treatment of tuberculosis
- Treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx 2
From the Research
Rifampin Uses
Rifampin, also known as rifampicin, is an antibiotic used to treat various infections, including:
- Tuberculous meningitis: Rifampin is used in combination with other drugs, such as isoniazid, pyrazinamide, and ethambutol, to treat tuberculous meningitis, a highly morbid and often fatal disease 3, 4, 5, 6.
- Pulmonary tuberculosis: Rifampin is used in combination with other drugs to treat pulmonary tuberculosis, including cavitary pulmonary disease 7.
- Miliary disease: Rifampin may be used in combination with other drugs to treat miliary disease, a form of tuberculosis that affects multiple parts of the body 7.
- Prophylaxis: Isoniazid alone is adequate for prophylaxis, but rifampin may be used in combination with other drugs for prophylaxis in certain cases 7.
Dosage and Administration
The dosage and administration of rifampin vary depending on the specific infection being treated and the patient's age and weight. For example:
- In children with tuberculous meningitis, daily doses of at least 30 mg/kg orally or 15 mg/kg intravenously may be required to attain target rifampin exposures 3.
- In Vietnamese children with tuberculous meningitis, simulation results suggested that rifampin dosing at 50 mg/kg of body weight/day would be required to achieve the target exposure 6.
Important Considerations
When using rifampin, it is essential to consider the following:
- Hepatotoxicity: Rifampin can cause hepatotoxicity, especially when used in combination with other drugs, such as isoniazid 4.
- Resistance: The major cause of treatment failure is resistance of tubercle bacilli to the antimicrobial agents used, including rifampin 7.
- Compliance: The major cause of therapeutic failure is noncompliance of the patient in taking the medication regularly 7.