Rifampin (rifampicin)

What is Rifampin

Rifampin (rifampicin), a semisynthetic rifamycin antibiotic, is primarily used as part of first-line, combination therapy in the treatment of tuberculosis.

Rifampin is also used to treat asymptomatic carriers of Neisseria meningitidis; as prophylaxis against Haemophilus influenzae type b in high-risk contacts; and in the treatment of rare diseases such as Hansen’s disease (leprosy), bartonellosis, and brucellosis. Rifampin has been used in combination with vancomycin for synergy in staphylococcal infections; however, data are insufficient to support its routine use.

Indications

  1. bacteremia
  2. bacterial colonization eradication
  3. bartonellosis
  4. bone and joint infections
  5. brain abscess
  6. endocarditis
  7. Haemophilus influenzae (beta-lactamase negative)
  8. Haemophilus influenzae (beta-lactamase positive)
  9. Haemophilus influenzae type b prophylaxis
  10. leprosy (Hansen’s disease)
  11. meningitis
  12. meningococcal infection prophylaxis
  13. Mycobacterium leprae
  14. Mycobacterium tuberculosis
  15. Neisseria meningitidis
  16. orthopedic device-related infection
  17. osteomyelitis
  18. pruritus
  19. Staphylococcus aureus (MRSA)
  20. Staphylococcus aureus (MSSA)
  21. Staphylococcus epidermidis
  22. subdural empyema
  23. tuberculosis infection
  24. tuberculosis prophylaxis
  25. ventriculitis

Side Effects

  1. acute generalized exanthematous pustulosis (AGEP)
  2. agranulocytosis
  3. anaphylactoid reactions
  4. anemia
  5. angioedema
  6. anorexia
  7. ataxia
  8. bleeding
  9. bone pain
  10. bronchospasm
  11. chest pain (unspecified)
  12. chills
  13. cholestasis
  14. confusion
  15. conjunctivitis
  16. contact lens discoloration
  17. cough
  18. diarrhea
  19. disseminated intravascular coagulation (DIC)
  20. dizziness
  21. drowsiness
  22. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  23. dyspnea
  24. elevated hepatic enzymes
  25. eosinophilia
  26. erythema multiforme
  27. fatigue
  28. fever
  29. flatulence
  30. flushing
  31. headache
  32. hematuria
  33. hemolysis
  34. hemolytic anemia
  35. hepatic failure
  36. hepatitis
  37. hepatotoxicity
  38. hyperbilirubinemia
  39. hyperuricemia
  40. hypotension
  41. interstitial nephritis
  42. intracranial bleeding
  43. jaundice
  44. leukopenia
  45. lymphadenopathy
  46. menstrual irregularity
  47. myalgia
  48. myopathy
  49. nausea
  50. neutropenia
  51. palpitations
  52. pemphigus
  53. peripheral edema
  54. porphyria
  55. pruritus
  56. pseudomembranous colitis
  57. psychosis
  58. purpura
  59. pyrosis (heartburn)
  60. rash
  61. renal failure (unspecified)
  62. renal tubular necrosis
  63. Stevens-Johnson syndrome
  64. superinfection
  65. syncope
  66. thrombocytopenia
  67. tooth discoloration
  68. toxic epidermal necrolysis
  69. urine discoloration
  70. urticaria
  71. vasculitis
  72. visual impairment
  73. vitamin B6 deficiency
  74. vitamin D deficiency
  75. vomiting
  76. weakness
  77. wheezing

Monitoring Parameters

  • CBC
  • INR
  • LFTs
  • platelet count
  • prothrombin time (PT)
  • serum creatinine

Contraindications

  • acquired immunodeficiency syndrome (AIDS)
  • anticoagulant therapy
  • antimicrobial resistance
  • breast-feeding
  • colitis
  • contact lenses
  • diabetes mellitus
  • diarrhea
  • extravasation
  • geriatric
  • GI disease
  • hepatic disease
  • human immunodeficiency virus (HIV) infection
  • inflammatory bowel disease
  • intramuscular administration
  • malnutrition
  • porphyria
  • pregnancy
  • pseudomembranous colitis
  • rifamycin hypersensitivity
  • subcutaneous administration
  • ulcerative colitis
  • vitamin K deficiency

Interactions

  • Abacavir; Dolutegravir; Lamivudine
  • Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
  • Abemaciclib
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  • Acalabrutinib
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  • Acetaminophen; Caffeine
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  • Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
  • Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
  • Acetaminophen; Dextromethorphan
  • Acetaminophen; Dextromethorphan; Doxylamine
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  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Guaifenesin; Phenylephrine
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  • Acetaminophen; Oxycodone
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  • food
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