Advertising revenue supports our not-for-profit mission. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. This site complies with the HONcode standard for trustworthy health information: verify here. This content does not have an English version. This content does not have an Arabic version.
See more conditions. Drugs and Supplements Rifampin Oral Route. Skin and Mucus Membrane Products. Therapeutic Vaccines.
Bacterial Enteric Infections. Mucocutaneous Candidiasis. Cytomegalovirus Disease. Disseminated Mycobacterium avium Complex Disease. Toxoplasma gondii Encephalitis. Human Herpesvirus-8 Diseases. Herpes Simplex Virus Disease. Varicella-Zoster Virus Diseases. Hepatitis B Virus Infection. Hepatitis C Virus Infection. Herpes Zoster. Pneumocystis Pneumonia. Penicilliosis marneffei. Drug information Audio. Your browser does not support the audio element. Other Names:.
Drug Class:. What is rifampin? How is rifampin used in people with HIV? See the Adult and Pediatric Opportunistic Infection Guidelines for complete information on recommended uses of rifampin in adults and children with HIV.
Rifampin may have other recommended uses not listed above. What should I tell my health care provider before taking rifampin? What should I tell my health care provider before using rifampin?
Before using rifampin, tell your health care provider: If you are allergic to rifampin, rifabutin , rifapentine or any other medicines. About any medical conditions you have or have had, including: Liver problems Diabetes Porphyria a group of genetic disorders that affect the skin or nervous system Bleeding problems or blood clotting disorders Vitamin K deficiency About anything that could affect your ability to take medicines, such as difficulty swallowing pills, difficulty remembering to take pills, or any health conditions that may prevent your use of intravenous IV medicines.
Make sure you tell your doctor if you have any other medical problems, especially:. Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
To do so may increase the chance for side effects. To help clear up your tuberculosis TB completely, it is very important that you keep using this medicine for the full time of treatment, even if you begin to feel better after a few weeks. If you have TB, you might have to take rifampin every day for several months. It is important that you do not miss any doses.
Take the capsule on an empty stomach, 1 hour before or 2 hours after a meal, with a full of glass water. It is important to take this medicine on a regular schedule. If this medicine upsets your stomach, take it with food. Antacids may also help. They may keep this medicine from working properly. If you are taking itraconazole, do not use rifampin 2 weeks before and during itraconazole treatment.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine.
Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. If rifampin is taken on an irregular schedule, side effects may occur more often and may be more serious than usual.
If you have any questions about this, check with your doctor. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. In this large retrospective multicentre study, including patients with acute staphylococcal PJIs that were managed with surgical debridement, we demonstrated a clear benefit of a rifampin based regimen, even after correcting for potential sources of bias and confounding.
The most prominent effect of rifampin was observed in knees. Rifampin started within 5 days after surgical debridement was associated with a worse outcome, and a consistent superiority of the use of a fluoroquinolone was observed as co-antibiotic next to rifampin, but a clindamycin based regimen showed similar efficacy. We did not find an association between the rifampin dose and treatment failure. In a recent randomized controlled trial conducted in Norway, Karlsen et al.
Unfortunately, the study was underpowered to draw definitive conclusions, and in addition, rifampin was not combined with a fluoroquinolone or other agents active against biofilms, nor with antibiotics with adequate oral availability and bone penetration. The clear benefit of rifampin demonstrated in observational studies has been criticized because of confounding by indication and survival bias [ 8 , 14 , 15 ].
However, in our study, subanalyses in which confounding and bias were reduced to a minimum did not change the results, and consistently supported the use of rifampin in acute staphylococcal PJIs managed with DAIR. These results were most prominent in patients with a PJI of the knee. Our analysis demonstrated an association between the early start of rifampin i. Although this observation may be partially explained by the fact that patients who received rifampin within this time period entailed patients with more severe infections e.
To avoid the induction of rifampin resistance, it has been proposed by experts in the field [ 16—18 ], to wait for the start of rifampin after the wound is dry, drains have been removed, and at least 3—5 days of intravenous antibiotics have been given to secure adequate load reduction of bacteria. Therefore, early start may, theoretically, result in a higher failure rate.
Unfortunately, we did not collect data on the development of rifampin resistant strains during follow-up. A previous study did not report the development of rifampin resistant strains in a cohort where rifampin was started immediately after surgical debridement [ 19 ].
A possible explanation for the higher failure rate could be that rifampin works antagonistically with the co-antibiotic administered when bacteria are still in the planktonic phase [ 20 ], but future studies are necessary to draw definite conclusions on this matter. Different practices on rifampin dose exist in hospitals. Prescribing an insufficient low dose would theoretically lead to treatment failure, while prescribing a dose above the necessary threshold may result in more significant interactions with certain co-antibiotics, and therefore may lead to treatment failure.
These data are in line with the study performed by Nguyen et al. In our subanalysis of other co-antibiotics, the prescribed dose did not seem to have a substantial effect on treatment outcome either, suggesting that the enzyme induction of CYP3A4 by rifampin is not dose dependent.
Our results confirm the superiority of the use of fluoroquinolones, in which a trend was observed in favour of levofloxacin and moxifloxacin compared to ciprofloxacin. The latter finding is somewhat surprising, as rifampin lowers the serum concentration of clindamycin [ 23 ], and this has been shown in a previous analysis of Tornero et al. However, in the study of Tornerno et al. Indeed, a previous report, demonstrated a good clinical outcome when a clindamycin dose of mg TID is prescribed [ 24 , 25 ].
The reduction of serum levels of antibiotics induced by rifampin is not always clinically relevant and depends on the intrinsic activity of the antibiotic, the degree of reduction and the dosage of the co-antibiotic administered. This is supported by the high success rate of moxifloxacin combination therapy [ 26 ], an antibiotic that is also affected by rifampin [ 27 , 28 ]. In concordance with the study of Tornero et al. Our study has some limitations.
First, we only analysed treatment failure and clinical failure, but did not collect data on microbiological failure or on the development of resistance.
Second, with a minimum follow-up of 1 year, infection relapses with coagulase negative staphylococci may be missed. Third, since our study is observational, causality cannot be inferred and residual confounding may be present.
However, the use of multivariable regression techniques and subanalyses consistently showed identical results. In conclusion, even after minimizing potential confounding and bias, our data confirms the efficacy of rifampin in acute staphylococcal PJIs treated with surgical debridement, especially in prosthetic knees.
Next to a fluoroquinolone, clindamycin mg TID is a good alternative to use as co-antibiotic. Our data indicates, that the early start of rifampin i. Potential conflicts of interest. All other authors report no potential conflicts. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. Bone Joint J ; B : — 2. Google Scholar.
Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America.
Clin Infect Dis ; 56 : e1 — e A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clin Infect Dis ; 56 : — Correlation between in vivo and in vitro efficacy of antimicrobial agents against foreign body infections. J Infect Dis ; : 96 — Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. JAMA ; : — Rifampin combination therapy in staphylococcal prosthetic joint infections: a randomized controlled trial.
J Orthop Surg Res ; 15 : Rifampin-accompanied antibiotic regimens in the treatment of prosthetic joint infections: a frequentist and Bayesian meta-analysis of current evidence. Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention DAIR : a retrospective multicenter study in France.
J Bone Jt Infect ; 5 : 28 — Outcome of patients with streptococcal prosthetic joint infections with special reference to rifampicin combinations. BMC Infect Dis ; 16 : Risk factors for failure in early prosthetic joint infection treated with debridement. Influence of etiology and antibiotic treatment. J Appl Biomater Funct Mater ; 12 : —
0コメント