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Fixed-dose combinations of antituberculous medications to prevent drug resistance.

Abstract

The treatment of tuberculosis requires at least two drugs to retard the development of drug resistance. Unfortunately, patients may take only one drug (monotherapy) when more than one is prescribed. Fixed-dose combinations with two or more antituberculous drugs in one capsule or tablet are available to prevent this. In the United States, these drugs are Rifamate (Marion Merrell Dow), which contains isoniazid plus rifampin, and Rifater (Marion Merrell Dow), which contains isoniazid plus rifampin and pyrazinamide. Because these preparations make monotherapy impossible, they are clearly preferable to individual drugs. In the United States in 1993, however, only 15% to 18% of rifampin was sold in the form of fixed-dose combinations. To correct this deficiency, fixed-dose combinations should be widely promoted and accepted as a primary way to prevent drug-resistant tuberculosis. There are two caveats regarding these preparations. First, many fixed-dose combinations, especially those in developing countries, achieve inadequate blood levels of one or more of the component drugs, especially rifampin. Our recommendations apply only to preparations with proven bioavailability. Second, because the name Rifamate is similar to the name rifampin, mistakes in prescribing and dispensing can result in the patient receiving rifampin alone when Rifamate is intended. A name change from Rifamate to a highly distinctive name such as Rif-Isoniazid is needed to prevent such occurrences.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Respiratory and Critical Care Physiology and Medicine, Harbor-University of California, Los Angeles, Medical Center, Torrance 90501, USA.

    ,

    Source

    Annals of internal medicine 122:12 1995 Jun 15 pg 951-4

    MeSH

    Antitubercular Agents
    Drug Combinations
    Drug Resistance, Microbial
    Humans
    Isoniazid
    Pyrazinamide
    Rifampin

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.
    Review

    Language

    eng

    PubMed ID

    7755232

    Citation

    Moulding, T, et al. "Fixed-dose Combinations of Antituberculous Medications to Prevent Drug Resistance." Annals of Internal Medicine, vol. 122, no. 12, 1995, pp. 951-4.
    Moulding T, Dutt AK, Reichman LB. Fixed-dose combinations of antituberculous medications to prevent drug resistance. Ann Intern Med. 1995;122(12):951-4.
    Moulding, T., Dutt, A. K., & Reichman, L. B. (1995). Fixed-dose combinations of antituberculous medications to prevent drug resistance. Annals of Internal Medicine, 122(12), pp. 951-4.
    Moulding T, Dutt AK, Reichman LB. Fixed-dose Combinations of Antituberculous Medications to Prevent Drug Resistance. Ann Intern Med. 1995 Jun 15;122(12):951-4. PubMed PMID: 7755232.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Fixed-dose combinations of antituberculous medications to prevent drug resistance. AU - Moulding,T, AU - Dutt,A K, AU - Reichman,L B, PY - 1995/6/15/pubmed PY - 1995/6/15/medline PY - 1995/6/15/entrez SP - 951 EP - 4 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 122 IS - 12 N2 - The treatment of tuberculosis requires at least two drugs to retard the development of drug resistance. Unfortunately, patients may take only one drug (monotherapy) when more than one is prescribed. Fixed-dose combinations with two or more antituberculous drugs in one capsule or tablet are available to prevent this. In the United States, these drugs are Rifamate (Marion Merrell Dow), which contains isoniazid plus rifampin, and Rifater (Marion Merrell Dow), which contains isoniazid plus rifampin and pyrazinamide. Because these preparations make monotherapy impossible, they are clearly preferable to individual drugs. In the United States in 1993, however, only 15% to 18% of rifampin was sold in the form of fixed-dose combinations. To correct this deficiency, fixed-dose combinations should be widely promoted and accepted as a primary way to prevent drug-resistant tuberculosis. There are two caveats regarding these preparations. First, many fixed-dose combinations, especially those in developing countries, achieve inadequate blood levels of one or more of the component drugs, especially rifampin. Our recommendations apply only to preparations with proven bioavailability. Second, because the name Rifamate is similar to the name rifampin, mistakes in prescribing and dispensing can result in the patient receiving rifampin alone when Rifamate is intended. A name change from Rifamate to a highly distinctive name such as Rif-Isoniazid is needed to prevent such occurrences. SN - 0003-4819 UR - https://www.unboundmedicine.com/medline/citation/7755232/Fixed-dose_combinations_of_antituberculous_medications_to_prevent_drug_resistance L2 - https://www.annals.org/article.aspx?volume=122&issue=12&page=951 DB - PRIME DP - Unbound Medicine ER -