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Skin infections
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Shankila Mittal, Rashmi Sarkar
DecolonizationNasal decolonization may be done with twice daily application of mupirocin for 10 days.Body decolonization with antiseptic solutions like chlorhexidine (5–14 days) or dilute bleach baths (1 teaspoon of bleaching powder in 1 gallon of water or ¼ cup of bleaching powder per ¼ tub of water or 13 gallons of water) twice a week for 15 minutes for 3 months.All carriage sites like nasal, axilla, and perineum should be treated.Oral rifampicin 600 mg daily for 7–10 days may be used with due caution to the risk of resistance.
Rifampicin (Rifampin)
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
C. Alan, C. Street, Tony M. Korman
Rifampicin is a first-line agent for treatment of all forms of tuberculosis caused by organisms with known or presumed susceptibility to the drug. It has demonstrated early bactericidal activity (Jindani et al., 1980; Donald and Diacon, 2008), and also activity against semi-dormant bacterial populations, thus accounting for its sterilizing activity (Dickinson and Mitchison, 1981; Jindani et al., 2003).
Pharmacokinetic optimization of the treatment of TB meningitis with TB drugs
Published in Robert Hofstra, Noriyuki Koibuchi, Suthat Fucharoen, Advances in Biomolecular Medicine, 2017
A higher dose of i.v. rifampicin seems promising to achieve a better outcome of TBM treatment. However i.v. rifampicin is not easy; it is invasive, impractical, more expensive than oral drug, and not widely available. For this reason, first, we need to find an alternative for intravenous rifampicin that gives the same effect, i.e. a higher oral dose of rifampicin (i.e. 15 or 20 mg/kg, or even higher) with a similar PK/PD and safety profile to those of i.v. rifampicin. Rifampicin is a widely used drug and tolerated well by patients. In addition, it has been shown that a higher oral dose of rifampicin up to 35 mg/kg is well tolerated in African pulmonary TB patients (Boeree et al., 2015).
The cascade of care for pregnant women with latent tuberculosis infection in a high-income country
Published in Infectious Diseases, 2023
Åsa Arvidsson, Gihan Lafta, Martina Sönnerbrandt, Karin Sundelin, Jakob Paues
Pregnant women from countries with high TB incidence who seek Maternal Health Care (MHC) clinics are an opportunity to screen individuals that have not been screened previously and the Public Health Agency of Sweden recommends screening for TB in this group [12]. In Östergötland county such a screening program has been active since 2013. The screening criteria were pregnant women from high-endemic countries (>100 cases/100,000/year). Pregnant women with LTBI who are recently exposed to TB or have a compromised immune system are recommended to start prophylactic LTBI-treatment during the pregnancy. Otherwise, an individual assessment is done as soon as possible after childbirth [12]. Factors that could influence the decision to treat are, e.g. age, parity, recent TB exposure, previous treatment for latent or active TB and time in Sweden. It is known that age over 35 years increases the risk for hepatotoxicity [13] and that a recent exposure increases the risk of developing active TB [14]. How the number of previous pregnancies influences the risk of developing active TB is less known. Previous studies indicate that parity does not play a role [15,16]. LTBI treatment options are daily isoniazid for 6 or 9 months, rifampicin for 4 months or rifampicin plus isoniazid for 3 months [2]. Both rifampicin and isoniazid are safe to use during pregnancy [17,18]. The risk of drug-related adverse events should be balanced against the potential benefits of treatment [2].
Rifampicin in periprosthetic joint infections: where do we stand and where are we headed?
Published in Expert Review of Anti-infective Therapy, 2023
Marjan Wouthuyzen-Bakker, Henk Scheper
In 1957, a Milan research group led by Piero Sensi isolated a new class of antibiotics from the bacterium Streptomyces mediterranei from a French soil sample. This new antibiotic class was named rifamycins, after the then quite popular French gangster movie Rififi (which is a French word for: ‘trouble’). The abbreviation of the active ingredient (N-Amino-N′-MethylPiperazine) completed the name. The first rifamycin for clinical use, rifamycin SV, was replaced by rifampicin because of better bioavailability and efficacy, especially against Mycobacterium tuberculosis. Rifampicin inhibits bacterial RNA synthesis by binding to the β-subunit of the DNA-dependent RNA polymerase. Rifampicin appeared to be effective against Gram-positive and some Gram-negative bacteria also, and has demonstrated bactericidal activity against intracellular microorganisms [8]. However, its effectiveness against tuberculosis has led to a strong lobby of many physicians to discourage the use of rifampicin for non-tuberculous infections due to fear of increasing resistance. This resistance is known to occur if rifampicin is used as monotherapy or when treating infections with a very high bacterial load [9]. In 1980, Acocella et al. reported that the incidence of rifampicin-resistant tuberculosis strains was not higher in countries where rifampicin was frequently used in comparison with countries with a restrictive use of rifampicin and therefore concluded that this fear was unjustified [10]. Nowadays, it is a common antibiotic prescribed for foreign body-material-related infections, including PJI.
Improvement of cholestatic episodes in patients with benign recurrent intrahepatic cholestasis (BRIC) treated with rifampicin. A long-term follow-up
Published in Scandinavian Journal of Gastroenterology, 2023
Holmfridur Helgadottir, Geir Folvik, Mette Vesterhus
The mode of action of rifampicin in the management of pruritus in cholestatic diseases is through its function as a pregnane X receptor (PXR) agonist [22]. PXR is a nuclear receptor which plays a central role in bile acid synthesis and homeostasis, inducing CYP3A4 to hydroxylate bile acids and drugs [23]. Moreover, rifampicin may act via its antibiotic effect on the gut microbiome. It has been postulated that changes in secondary bile acid produced by the gut microbiota could act as a trigger, being affected by dietary change or gastroenteritis, where diminished numbers of bacteria would lead to reduced conversion to secondary bile acid in the gut [1,24]. Short-term use of rifampicin is considered safe [22,25] but there have been concerns over potential severe hepatotoxicity reported after long-term administration of rifampicin in cases with cholestatic diseases [26]. None of the cases in this series suffered side effects attributable to rifampicin, supporting a low risk of hepatotoxicity associated with episodic, short-term rifampicin therapy.