rifampin and Anaphylaxis

A male born in 1935 was diagnosed as having lepromatous leprosy when he was 17 years old. In addition to dapsone (DDS) monotherapy, he had been treated with rifampin (RMP) for 2 terms: first with 450 mg a day for 2 years when he was 39 years old; second with 150 mg a day for 2 months after a 1-year interval from the first regimen. During these entire courses with RMP, no complication was noted. When he was 64 years old in 1999, a diagnosis of relapsed borderline tuberculoid (BT) leprosy was made, and he was started on the multibacillary (MB) regimen of the World Health Organization multidrug therapy (WHO/MDT). After the third dose of monthly RMP, he developed a flu-like syndrome and went into shock. A few hours later, intravascular hemolysis occurred followed by acute renal failure. He was placed on hemodialysis for 7 series and recovered almost completely about 2 months later. The immune complexes with anti-RMP antibody followed by complement binding may have accounted for these symptoms. Twenty-four reported cases of leprosy who had developed side effects of RMP under an intermittent regimen were analyzed; 9 of the cases had had prior treatment with RMP but 15 had not. Adverse effects were more likely to occur in MB cases and were more frequent during the first 6 doses of intermittent regimens. The cases with prior treatment with RMP had had a higher incidence of serious complications such as marked hypotension, hemolysis and acute renal failure. However, many exceptions were also found, and we could not verify any fully dependable factor(s) to predict the side effects of RMP. More field investigation is desirable, and monthly administration of RMP must be conducted under direct observation through the course of WHO/MDT.

Topics: Adrenal Cortex Hormones; Anaphylaxis; Blood Chemical Analysis; Diuretics; Furosemide; Hemolysis; Humans; Leprostatic Agents; Leprosy, Lepromatous; Leprosy, Tuberculoid; Male; Middle Aged; Oliguria; Recurrence; Renal Dialysis; Rifampin

Vascular catheters impregnated with antimicrobial agents have been shown to decrease the risk of catheter-related colonization and bloodstream infections. Various antimicrobials and antiseptics have been used. In a recent meta-analysis of 12 studies, catheters coated with chlorhexidine and silver sulfadiazine (CH/SS) were shown to be significantly less likely to be associated with catheter-related bloodstream infections than uncoated catheters. However, these catheters were coated only on the external surface and they are associated with short antimicrobial durability (3-7 days). In addition, anaphylactic reactions to them were reported in Japan. Vascular catheters impregnated with minocycline and rifampin (M/R) were found to be highly efficacious in preventing catheter-related infections. In a recent prospective, randomized trial, the likelihood of catheter-related bloodstream infections associated with the use of M/R catheters was one-twelfth of that observed with catheters coated with CH/SS. The M/R catheters are coated on the external and internal surfaces and have an antimicrobial durability of 4 weeks. Although no resistance to either minocycline or rifampin has been seen in two trials, further studies are required to determine whether the risk of resistance outweighs the benefits derived from their use. In conclusion, antimicrobial catheters have been shown to be highly cost effective in decreasing the risk of catheter-related bloodstream infection.

Topics: Anaphylaxis; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Bacteremia; Bacterial Infections; Catheters, Indwelling; Chlorhexidine; Coated Materials, Biocompatible; Enzyme Inhibitors; Humans; Minocycline; Rifampin; Risk Assessment; Risk Factors; Silver Sulfadiazine

Many of the adverse events induced by rifampin have been considered allergic in origin. The flu-like syndrome and other hypersensitivity reactions seem to be caused by immune complexes, although their pathogenetic mechanisms are not fully elucidated. Many cases have been reported of the flu-like syndrome, thrombocytopenia, hemolytic anemia, and renal failure caused by rifampin. In almost all of the patients in whom they were sought, nonreaginic antirifampin antibodies were detected. On the other hand, anaphylactic reactions seem to be IgE-mediated. We have analyzed the 18 reported cases of anaphylactic reactions severe enough to cause marked hypotension. The interval between the onset of treatment and the anaphylactic reaction was highly variable. Most patients presented with prodromes, mainly rash, before the development of anaphylactic symptoms, and, in most cases, the reaction occurred after reexposure to rifampin. Clinical findings include a variety of symptoms, such as fever, exanthem, dyspnea, abdominal pain, and vomiting. Seven of the 9 patients in whom HIV status was known were seropositive, including the only 2 patients who died. We believe that, in case of a non-life-threatening adverse reaction caused by immune complexes, rifampin could be readministered, if necessary, at a more frequent and reduced dose, perhaps with the addition of corticosteroids. In case of anaphylactic reactions the drug should be avoided, although desensitization procedures may be useful. Certain laboratory findings may serve as a clue to predict anaphylactic reactions in patients who have experienced minor adverse events to rifampin. However, the diagnostic value of such findings is not well established and, therefore, patients with previous adverse reactions should be carefully monitored if reexposure to rifampin is essential.

Topics: Anaphylaxis; Antibiotics, Antitubercular; Drug Hypersensitivity; Humans; Incidence; Rifampin

Topics: Acute Kidney Injury; Anaphylaxis; Anemia, Hemolytic; Dose-Response Relationship, Drug; Drug Hypersensitivity; Humans; Hypotension; Purpura, Thrombocytopenic; Rifampin

Rifampicin (RFP) and pyrazinamide (PZA) are the primary anti-tubercular drugs with a considerably safe profile. However, none of the drugs are without adverse reactions. They both can lead to a variety of adverse effects including life-threatening anaphylaxis. We report an interesting and possibly the first case of concurrent hypersensitivity to two primary anti-tubercular treatment (ATT) drugs. Hypersensitivity to RFP and PZA was confirmed in this patient by drug provocation and intradermal skin testing. He improved on alternative ATT regime withdrawing RFP and PZA.

Topics: Anaphylaxis; Antitubercular Agents; Child; Drug Hypersensitivity; Humans; Male; Pyrazinamide; Rifampin; Tuberculosis, Meningeal

Topics: Aged; Anaphylaxis; Anesthesia, Spinal; Arthroplasty, Replacement, Knee; Bupivacaine; Diagnosis, Differential; Humans; Intraoperative Complications; Male; Rifampin

Topics: Acute Kidney Injury; Adult; Anaphylaxis; Anemia, Hemolytic; Antibiotics, Antitubercular; Disseminated Intravascular Coagulation; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Liver; Male; Renal Dialysis; Rifampin; Treatment Outcome; Tuberculosis, Pulmonary

The side effects of rifampicine due to an immunoallergic mechanism are rare and usually observed during discontinued treatment or administration of high doses.. An immediate hypersensitivity reaction with anaphylactic manifestations and increase in IgE occurred in a 39 year-old man suffering from resistant tuberculosis. The reaction occurred within the first hour following a low dose of rifampicin administered in a desensitisation attempt, the outcome of which was favourable after administration of corticosteroids and antihistamines. A type II hypersensitivity reaction occurred in a 76 year-old male patient in the form of thrombopenia on D76 of a twice weekly treatment, diagnosed because of hemoptysis with normalisation of platelet level on withdrawal of rifampicin. An immune complex hypersensitivity reaction was responsible for hepato-renal failure on D68 of twice weekly treatment and required permanent withdrawal of rifampicin and dialysis, which led to subsequent improvement.. These clinical cases illustrate the variability of the hypersensitivity mechanisms observed with rifampicin, the difficulty in imputability tests and methods for immunological confirmation, the interest of continuous treatment which avoids a certain number of these accidents, and that of desensitisation during immediate hypersensitive reactions which permits the continuation this major anti-tuberculosis drug.

Topics: Acute Kidney Injury; Adult; Aged; Anaphylaxis; Antibiotics, Antitubercular; Antigen-Antibody Complex; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Hypersensitivity, Immediate; Liver Failure; Male; Platelet Count; Rifampin; Thrombocytopenia; Time Factors

The usefulness of the lymphocyte transformation test (LTT) for the analysis of adverse reactions to antituberculous drugs was evaluated. - The LTT was performed with isoniazid and rifampicin in 15 tuberculosis and 2 MOTT (Mycobacteria other than tuberculosis)-infection patients who suffered drug reactions, in 23 patients without any adverse reactions, in 7 controls previously exposed to antituberculous drugs, and in 14 controls who had never been exposed. 4/15 of the hepatotoxic reactions only showed a positive LTT with rifampicin, 3/15 only with isoniazid, and in 8/15 the LTT was negative. In an anaphylactoid shock reaction the LTT was extremely exaggerated for both rifampicin and isoniazid. In patients without any side effects only one slightly increased LTT due to isoniazid was observed. Two healthy controls with previous contact to these drugs showed a positive LTT for isoniazid, one of those with both rifampicin and isoniazid. The LTT was negative in all control persons without any former contact to antituberculous medications. In most cases hepatotoxicity seems to be a pure toxic reaction without the participation of cellular immune mechanisms. LTT can be useful for identifying the drug responsible for immunological side effects.

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Antitubercular Agents; Bromodeoxyuridine; Cells, Cultured; Chemical and Drug Induced Liver Injury; DNA Replication; Drug Eruptions; Drug Hypersensitivity; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunity, Cellular; Isoniazid; Kidney Diseases; Leukocytes, Mononuclear; Lymphocyte Activation; Male; Middle Aged; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Nervous System Diseases; Rifampin; Tuberculosis

Topics: Administration, Topical; Adult; Anaphylaxis; Antibiotics, Antitubercular; Drug Hypersensitivity; Female; Humans; Male; Ophthalmic Solutions; Rifampin

Topics: Adult; Anaphylaxis; Antibiotics, Antitubercular; Antitubercular Agents; Cerebral Infarction; Drug Hypersensitivity; Drug Therapy, Combination; HIV Infections; Humans; Isoniazid; Male; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary

We report the case of a 28-year-old-prostitute from Thailand with HIV infection stage B2 associated with retroperitoneal lymph node tuberculosis. 6 days after the beginning of anti-tuberculous therapy (isoniazid, rifampicin, pyrazinamid and ethambutol) the temperature rose to 40.5 degrees C, diarrhea, vomiting, and tachycardia developed and systolic blood pressure fell to 80 mm Hg. Liver function tests revealed acute hepatic failure (ALT 800 IU/l rising to 1500; serum bilirubin 89 mumol/l rising to 238.0; alkaline phosphatase 199 IU/l; glucose 1.8 mmol/l; prothrombin time 20%). Isoniazid, rifampicin, and pyrazinamid were replaced by streptomycin and PAS. A few days after withdrawal the liver profile returned to normal. Hours after the reintroduction of rifampicin total body erythema, pruritus, vomiting and severe hypotension developed, requiring saline methylprednisolone and epinephrine administration. The next reexposure to intravenous rifampicin produced a rash and was rapidly discontinued. Liver function tests remained normal. Later mild adverse reactions to streptomycin and pyrazinamid occurred, two drugs which had been well tolerated before. Subsequently the diagnosis of adrenal insufficiency was established. After initiation of steroid replacement (50 mg prednisolone) the antituberculous therapy with isoniazid, pyrazinamid and ethambutol was well tolerated. We conclude that the shock in this HIV-infected patient was either due to severe anaphylaxis to rifampicin or acute adrenal insufficiency ensuing on this drug. The reversible fulminant acute hepatic failure represents either an adverse effect of antituberculous drugs, especially hepatotoxic interactions of drug combinations, or an ischemic liver injury during hypotension caused by anaphylaxis. The case illustrates the complex nature of side effects of antituberculous drugs in HIV patients and their aggravation by adrenal insufficiency.

Topics: Adrenal Insufficiency; Adult; Anaphylaxis; Antibiotics, Antitubercular; Female; HIV Infections; Humans; Liver Failure; Prednisolone; Rifampin

Topics: Adult; Anaphylaxis; Antibiotics, Antitubercular; HIV Infections; Humans; Male; Rifampin; Tuberculosis, Lymph Node

Many reports have shown that rifampicin could induce a variety of adverse effects. However, anaphylactic shock occurring after readministration of rifampicin, to our knowledge, has not been reported thoughtfully. Herein we present a case with anaphylactic shock after readministration of rifampicin. The possible mechanism may be the interaction between IgE antibody and mast cell or basophils. Compared with continuous regimen, intermittent rifampicin regimen has longer interval to accumulate more rifampicin-induced antibodies, and more immunogenic side effects are the sequelae when re-encountered with rifampicin.

Topics: Aged; Anaphylaxis; Drug Hypersensitivity; Humans; Male; Rifampin

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Male; Peritonitis; Rifampin; Staphylococcal Infections

Topics: Acquired Immunodeficiency Syndrome; Adult; Anaphylaxis; Ciprofloxacin; Humans; Male; Rifampin; Tuberculosis

The aim of this prospective study was to evaluate the incidence of allergic reactions to drugs compared to other kinds of medical emergencies admitted to the main Hospital in Milan during a 6 months period. At the same time we drew a list of drugs most frequently involved in allergic reactions, and a list of the most frequent symptoms. Using special forms, the medical staff collected patients' data: age, history of atopy, identification of the drug causing the reaction, and any previous reactions. Among 11,407 cases of medical emergencies, we found 163 (1.43%) patients showing drug reactions: the mean age was 27.3; 58.90% were female; atopy was present in 16.56%. The drugs most frequently involved were: pyrazon group (22%); ASA (20.86%); penicillin and derivatives (9.20%); sulfa drugs (6.14%); group B vitamins (4.30%); tetanus toxoid (4.30%); hyposensitizing extracts (3.68%); propionic acid derivatives (2.46%); paracetamol (1.84%); indomethacin (1.23%); rifampicin (1.23%); erythromycin (1.23%); glafenine (1.23%); others (17.80%). Urticaria and/or angioedema were the most frequent symptoms (86.51%), then anaphylactic shock (9.81%) and asthma (3.68%) with regard to anaphylactic shock only 6.20% of the patients had had a previous reaction to the same drug. From these data we can see that the incidence of drug reactions is very low compared to other medical emergencies; penicillin evidenced fewer reactions than expected, while the pyrazon group and ASA confirmed the data from literature.

Topics: Acetaminophen; Adult; Anaphylaxis; Angioedema; Aspirin; Asthma; Drug Hypersensitivity; Emergencies; Erythromycin; Female; Glafenine; Humans; Indomethacin; Italy; Male; Penicillins; Propionates; Prospective Studies; Pyridazines; Rifampin; Urticaria; Vitamin B Complex

Topics: Acute Kidney Injury; Adult; Anaphylaxis; Antitubercular Agents; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Rifampin

The studies with 60 guinea pigs and 111 albino mice showed that the daily use of rifampicin for a prolonged period of time in an oral dose of 30 mg/kg for the guinea pigs and 20 mg/kg for the mice had a pronounced effect on the immunological reactivity of the host. The use of rifampicin for 3 months resulted in changed in the structure of the lymphoid organs and suppression of T-lymphocytes. It had an inhibitory effect on the development of the anaphylactic shock in response to the resolution dose of the foreign serum. The preliminary treatment of the mice with rifampicin for 2 months lowered the primary and to a greater extent the secondary immune response induced by the sheep red blood cells.

Topics: Anaphylaxis; Animals; Guinea Pigs; Immunity, Innate; Lymphocyte Activation; Mice; Rifampin; Rosette Formation; T-Lymphocytes; Time Factors

Topics: Abdomen, Acute; Adolescent; Adult; Anaphylaxis; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Rifampin; Streptomycin

Topics: Adult; Anaphylaxis; Drug Hypersensitivity; Humans; Male; Rifampin; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Adult; Aged; Anaphylaxis; Chronic Disease; Female; Humans; Male; Methods; Middle Aged; Rifampin; Tuberculosis, Pulmonary

Topics: Anaphylaxis; Hemorrhage; Humans; Male; Middle Aged; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Aged; Agranulocytosis; Anaphylaxis; Antitubercular Agents; Capreomycin; Cycloserine; Drug Hypersensitivity; Ethambutol; Ethionamide; Female; Humans; Isoniazid; Kanamycin; Pyrazinamide; Rifampin; Thrombocytopenia; Viomycin