rifampin and Birth-Weight

This study aims to examine the use and safety of rifampin in the hospitalized infants.. Observational study of clinical and laboratory adverse events among infants exposed to rifampin from 348 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2012.. Overall, 2,500 infants received 4,279 courses of rifampin; mean gestational age was 27 weeks (5th, 95th percentile; 23, 36) and mean birth weight was 1,125 g (515; 2,830). Thrombocytopenia (121/1,000 infant days) and conjugated hyperbilirubinemia (25/1,000 infant days) were the most common laboratory adverse events. The most common clinical adverse events were medical necrotizing enterocolitis (64/2,500 infants, 3%) and seizure (60/2,500 infants, 2%).. The overall incidence of adverse events among infants receiving rifampin appears low; however, additional studies to further evaluate safety and dosing of rifampin in this population are needed.

Topics: Antibiotics, Antitubercular; Birth Weight; Enterocolitis, Necrotizing; Female; Gestational Age; Hospitalization; Humans; Hyperbilirubinemia; Infant; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Male; Rifampin; Seizures; Thrombocytopenia

Reduced antituberculosis drug concentrations may contribute to unfavorable treatment outcomes among HIV-infected patients with more advanced immune suppression, and few studies have evaluated pharmacokinetics of the first-line antituberculosis drugs in such patients given fixed-dose combination tablets according to international guidelines using weight bands. In this study, pharmacokinetics were evaluated in 60 patients on 4 occasions during the first month of antituberculosis therapy. Multilevel linear mixed-effects regression analysis was used to examine the effects of age, sex, weight, drug dose/kilogram, CD4(+) lymphocyte count, treatment schedule (5 versus 7 days/week), and concurrent antiretrovirals (efavirenz plus lamivudine plus zidovudine) on the area under the concentration-time curve from 0 to 12 h (AUC(0-12)) of the respective antituberculosis drugs and to compare AUC(0-12)s at day 8, day 15, and day 29 with the day 1 AUC(0-12). Median (range) age, weight, and CD4(+) lymphocyte count were 32 (18 to 47) years, 55.2 (34.4 to 98.7) kg, and 252 (12 to 500)/μl. For every 10-kg increase in body weight, the predicted day 29 AUC(0-12) increased by 14.1% (95% confidence interval [CI], 7.5, 20.8), 14.1% (95% CI, -0.7, 31.1), 6.1% (95% CI, 2.7, 9.6) and 6.0% (95% CI, 0.8, 11.3) for rifampin, isoniazid, pyrazinamide, and ethambutol, respectively. Males had day 29 AUC(0-12)s 19.3% (95% CI, 3.6, 35.1) and 14.0% (95% CI, 5.6, 22.4) lower than females for rifampin and pyrazinamide, respectively. Level of immune suppression and concomitant antiretrovirals had little effect on the concentrations of the antituberculosis agents. As they had reduced drug concentrations, it is important to review treatment responses in patients in the lower weight bands and males to inform future treatment guidelines, and revision of doses in these patients should be considered.

Topics: Adolescent; Adult; Age Factors; Aged; Antitubercular Agents; Birth Weight; Drug Resistance, Multiple; Female; HIV Infections; Humans; Isoniazid; Male; Middle Aged; Pyrazinamide; Retrospective Studies; Rifampin; Sex Factors; Tuberculosis, Pulmonary; Young Adult

A premature twin of 1.9 kg had mitral valve endocarditis develop during neonatal intensive care. Vegetation involving the entire anterior mitral valve leaflet was identified. Reconstruction was achieved by near complete resection of the anterior mitral valve leaflet and retention of the peripheral margin of coaptation including primary and secondary chordae. The body of the anterior mitral valve leaflet was reconstructed using fresh autologous pericardium, a technique not previously reported in an infant of this size. Three and a half years later, the child is well and has required no further intervention.

Topics: Bioprosthesis; Birth Weight; Captopril; Combined Modality Therapy; Diseases in Twins; Diuretics; Endocarditis, Bacterial; Female; Gentamicins; Humans; Hypertension, Pulmonary; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Methicillin Resistance; Mitral Valve; Mitral Valve Insufficiency; Pericardium; Rifampin; Staphylococcal Infections; Transplantation, Autologous; Twins, Monozygotic; Vancomycin

There are 1565 premature and full-term deliveries in patients with tuberculosis at The New York Hospital included in this report. About 10% of the patients had active pulmonary tuberculosis immediately before or during gestation. The obstetric management of the patient with inactive tuberculosis is similar to that of the nontuberculous woman. In patients with active or recently active tuberculosis, delivery under regional anesthesia, with forceps when necessary to avoid excessive straining during the second stage of labor, is advised. Tuberculosis is not an indication for cesarean section. Chemotherapy is now the cornerstone of all therapy for tuberculosis; the various regimens and modifications depend on the type and extent of the disease. The best combination of drugs is isoniazid and ethambutol. Therapy in all cases must be multiple drug, continuous, and long-term. Prophylactic isoniazid is used infrequently during pregnancy and only in special circumstances. Results of treatment with the newer antituberculosis drugs show that the disease progressed in less than 1% of patients between 1957 and 1972 compared to 3 to 4% of patients from 1933 to 1956. Infants born to the 1565 tuberculous mothers reported here were of average weight, and none of the 1588 infants (23 sets of twins) had congenital tuberculosis. Patients should be carefully followed postpartum with sputum tests and x-rays. They should also be given medical and socioeconomic counseling.

Topics: Antitubercular Agents; BCG Vaccine; Birth Weight; Delivery, Obstetric; Ethambutol; Female; Humans; Isoniazid; New York City; Parity; Pneumothorax, Artificial; Pregnancy; Pregnancy Complications, Infectious; Rest; Rifampin; Streptomycin; Tuberculosis, Pulmonary