Rifamycins

Rifamycins is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Rifamycins exert bactericidal activity on susceptible mycobacteria by inhibiting DNA-dependent RNA polymerase, thereby halting transcription.

  • Rifampin (600 mg PO q24h or twice a week) is an integral component of most TB treatment regimens. It is also active against many gram-positive and gram-negative bacteria. Rifampin is used as adjunctive therapy in staphylococcal prosthetic valve endocarditis and prosthetic bone and joint infections (300 mg PO q8h) and for prophylaxis of close contacts of patients with Neisseria meningitidis infection (600 mg PO q12h). The drug is well absorbed orally and is widely distributed throughout the body including the cerebrospinal fluid (CSF).
  • Rifabutin (300 mg PO q24h) is primarily used to treat TB and MAC infections in HIV-positive patients who are receiving highly active antiretroviral therapy because it has fewer drug–drug interactions and less deleterious effects on protease inhibitor metabolism than does rifampin (see Chapter 16, Sexually Transmitted Infections, Human Immunodeficiency Virus, and Acquired Immunodeficiency Syndrome).
  • Rifapentine (usual dose between 600 and 900 mg PO weekly based on body weight) is primarily used in combination with isoniazid for 12-week once-weekly treatment of latent tuberculosis infection.

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General Principles

Rifamycins exert bactericidal activity on susceptible mycobacteria by inhibiting DNA-dependent RNA polymerase, thereby halting transcription.

  • Rifampin (600 mg PO q24h or twice a week) is an integral component of most TB treatment regimens. It is also active against many gram-positive and gram-negative bacteria. Rifampin is used as adjunctive therapy in staphylococcal prosthetic valve endocarditis and prosthetic bone and joint infections (300 mg PO q8h) and for prophylaxis of close contacts of patients with Neisseria meningitidis infection (600 mg PO q12h). The drug is well absorbed orally and is widely distributed throughout the body including the cerebrospinal fluid (CSF).
  • Rifabutin (300 mg PO q24h) is primarily used to treat TB and MAC infections in HIV-positive patients who are receiving highly active antiretroviral therapy because it has fewer drug–drug interactions and less deleterious effects on protease inhibitor metabolism than does rifampin (see Chapter 16, Sexually Transmitted Infections, Human Immunodeficiency Virus, and Acquired Immunodeficiency Syndrome).
  • Rifapentine (usual dose between 600 and 900 mg PO weekly based on body weight) is primarily used in combination with isoniazid for 12-week once-weekly treatment of latent tuberculosis infection.

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