rifampin and Bone-Diseases

This paper reports the nature, incidence, and severity of adverse reactions to regimens of rifampicin and ethambutol given once weekly, twice weekly, or daily and to a standard reserve regimen in a total of 330 Chinese failure patients who completed at least six months' chemotherapy in a therapeutic comparison in Hong Kong.The adverse reactions which occurred on the regimens of intermittent rifampicin were termed cutaneous, abdominal, "flu", and respiratory; in addition, purpura and abnormal liver function tests were encountered. There was an association of adverse reactions with the interval between doses and with the dose size of rifampicin, the highest incidence occurring with once-weekly rifampicin in high dosage. A procedure was developed for managing adverse reactions to intermittent rifampicin. Of 202 patients treated with intermittent rifampicin 60 developed adverse reactions, but in only 7 (3%) was it necessary to terminate the drug, though a further 10 (5%) were changed to daily rifampicin. On daily rifampicin, generalized hypersensitivity, cutaneous reactions, (one with purpura), and impaired liver function were encountered. Adverse reactions on the standard ethionamide, pyrazinamide, and cycloserine regimen were frequent and some were serious.

Topics: Alanine Transaminase; Antitubercular Agents; Bone Diseases; Chemical and Drug Induced Liver Injury; Colic; Drug Eruptions; Dyspnea; Ethambutol; Fever; Hong Kong; Humans; Jaundice; Purpura; Rifampin; Time Factors; Tuberculosis, Pulmonary

The objective of this study was to evaluate antimicrobial therapy outcomes of bone and joint infections (BJI) caused by Clostridium perfringens. We investigated remission of symptoms and the absence of relapse or reinfection during follow-up. Among the 8 patients with C. perfringens BJI, the type of infection was early prosthesis infection (n = 2), osteosynthetic device infection (n = 4), and chronic osteomyeletis (n = 2). Clindamycin-rifampicin combination was given in 4 cases and metronidazole in 4 cases. The overall success rate was 87.5%. Among the 7 patients who completed antibiotic treatment, the success rate was 100%. The clindamycin-rifampicin combination appeared to be effective in patients with C. perfringens BJI.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bone Diseases; Clindamycin; Clostridium Infections; Clostridium perfringens; Female; Humans; Joint Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Rifampin

An important clindamycin-rifampicin pharmacokinetic (PK) interaction has been reported, but the potential influence of the clindamycin administration route on that interaction is unknown. This prospective, observational, comparative PK study was undertaken to characterize and analyse the impact of the route, comparing the rifampicin enzyme-inductor effects on clindamycin clearance (CLclin) for oral versus intravenous (IV) administration.. Patients with bone-and-joint infections (BJIs) were treated with clindamycin monotherapy (n = 20) or clindamycin-rifampicin combination therapy (n = 19). Patients received continuous IV clindamycin infusion for 2-6 weeks, followed by an oral regimen. Liquid chromatography-mass spectrometry was used to measure plasma clindamycin concentrations at the end of IV and after 2 weeks of oral treatment. The ratios of the mean CLclin for the combination and monotherapy groups were calculated for IV (Riv) and oral (Rpo) routes, with the final ratio, Rf = Rpo/Riv, representing the fold change of the rifampicin-inducing effect from the IV to the oral route.. The magnitude of this interaction was markedly increased by oral intake, questioning the use of oral treatment for difficult-to-treat infections like BJIs. Nevertheless, the clindamycin-rifampicin combination seems possible provided that clindamycin is administered by continuous IV infusion.

Topics: Administration, Intravenous; Administration, Oral; Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone Diseases; Clindamycin; Female; Humans; Joint Diseases; Male; Middle Aged; Prospective Studies; Rifampin

The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear.. A cohort of streptococcal PJIs was reviewed retrospectively in seven reference centers for the management of complex bone and joint infections, covering the period January 1, 2010 to December 31, 2012.. Seventy patients with monomicrobial infections were included: 47 had infections of total hip arthroplasty and 23 had infections of total knee arthroplasty. The median age was 77 years (interquartile range (IQR) 69-83 years), the median Charlson comorbidity score was 4 (IQR 3-6), and 15.6% (n=11) had diabetes. The most commonly identified streptococcal species were Streptococcus agalactiae and Streptococcus dysgalactiae (38.6% (n=27) and 17.1% (n=12), respectively). Debridement, antibiotics and implant retention (DAIR) was performed after a median time of 7 days (IQR 3-8 days), with polyethylene exchange (PE) in 21% of cases. After a minimum follow-up of 2 years, 27% of patients had relapsed, corresponding to 51.4% of DAIR treatment cases and 0% of one-stage (n=15) or two-stage (n=17) exchange strategy cases. Rifampicin or levofloxacin in combination therapy was not associated with a better outcome (adjusted p= 0.99). S. agalactiae species and DAIR treatment were associated with a higher risk of failure. On multivariate analysis, only DAIR treatment and S. agalactiae were independent factors of relapse. Compared to DAIR without PE, DAIR with PE was only associated with a trend towards a benefit (odds ratio 0.33, 95% confidence interval 0.06-1.96; adjusted p= 0.44).. Streptococcal PJIs managed with DAIR have a poor prognosis and S. agalactiae seems to be an independent factor of treatment failure.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bone Diseases; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Female; Hip Prosthesis; Humans; Joint Diseases; Knee Prosthesis; Levofloxacin; Male; Prognosis; Prosthesis-Related Infections; Recurrence; Retrospective Studies; Rifampin; Streptococcal Infections; Streptococcus; Streptococcus agalactiae; Treatment Failure; Treatment Outcome

Mesoporous nanocrystalline hydroxyapatite (nHAp) rods of size 40-75 nm long and 25 nm wide (resembling bone mineral) were synthesized under microwave irradiation without using any surfactants or modifiers. The surface area and average pore size of the nHAp were found to be 32 m(2) g(-1) and 4 nm, respectively. Rifampicin (RIF) and ciprofloxacin (CPF) loaded nHAp displayed an initial burst followed by controlled release (zero order kinetics). Combination of CPF and RIF loaded nHAp showed enhanced bacterial growth inhibition against Staphylococcus aureus (S. aureus), Staphylococcus epidermidis (S. epidermidis) and Escherichia coli (E. coli) compared to individual agent loaded nHAp and pure nHAp. In addition, decreased bacterial adhesion (90%) was observed on the surface of CPF plus RIF loaded nHAp. The biocompatibility test toward MG63 cells infected with micro-organisms showed better cell viability and alkaline phosphatase activity (ALP) for the combination of CPF and RIF loaded nHAp. The influence on cell viability of infected MG63 cells was attributed to the simultaneous and controlled release of CPF and RIF from nHAp, which prevented the emergence of subpopulations that were resistant to each other. Hence, apart from the issue of the rapid synthesis of nHAp without surfactants or modifiers, the simultaneous and controlled release of dual drugs from nHAp would be a simple, non-toxic and cost-effective method to treat bone infections.

Topics: Alkaline Phosphatase; Anti-Bacterial Agents; Bacterial Adhesion; Bone and Bones; Bone Diseases; Cell Line, Tumor; Cell Proliferation; Cell Survival; Ciprofloxacin; Durapatite; Escherichia coli; Humans; Microbial Sensitivity Tests; Microwaves; Nanotechnology; Nanotubes; Rifampin; Spectrophotometry, Ultraviolet; Spectroscopy, Fourier Transform Infrared; Staphylococcus aureus; Staphylococcus epidermidis; Surface Properties; Surface-Active Agents; X-Ray Diffraction

The main characteristics of clindamycin are adequate for treatment of osteoarticular infections (OAI): good bone diffusion, broad spectrum of antibacterial activity and oral use.. A number of 61 patients was included in an observational retrospective study of efficacy and tolerance.. Prosthetic infections accounted for 50.8% of the cases and chronic osteitis for 36.1%. The causative micro-organisms were Staphylococci (72.2%) and Streptococci (15.3%); 86.5% of these strains were susceptible to erythromycin, 9.6% were erythromycin resistant and susceptible to lincomycin. Clindamycin was associated with either ofloxacine, rifampicin, or teicoplanin in 88.5% and the average course duration was 101 days. A surgical procedure was performed in 84% of cases. Complete cure was obtained in 91.1% at 18 months of follow up. Only one cutaneous rash and one Clostridium difficile-associated diarrhea occurred. The other adverse effects were gastrointestinal in 36%, cutaneous in 6.6%, and hematological in 1.6%, but did not lead to discontinuation of therapy.. Clindamycin can be used in OAI in association with or as an alternative to rifampicin, fluoroquinolones, or glycopeptides according to microbiological data.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bone Diseases; Clindamycin; Diarrhea; Drug Therapy, Combination; Drug Tolerance; Female; Humans; Joint Diseases; Male; Middle Aged; Ofloxacin; Osteitis; Prosthesis Implantation; Retrospective Studies; Rifampin; Staphylococcal Infections; Surgical Procedures, Operative; Teicoplanin

Brucellosis may show itself only through its bone and muscle complications, especially in the lumbar region, such as vertebral colliquation or psoas abscess. The authors describe a case of brucellosis (56 year old male, butcher) with lumbar bone and muscle involvement. The first symptom was a persistent pain of the right lumbar region, with irradiation to the homolateral leg. At admission the patient showed a lumbar cutaneous fistula with pus-like secretion. Quick diagnosis and therapy can prevent irreparable damage, even when the symptoms are silent.

Topics: Animals; Anti-Bacterial Agents; Bone Diseases; Brucellosis; Cattle; Diagnosis, Differential; Doxycycline; Humans; Ilium; Lumbar Vertebrae; Male; Middle Aged; Muscular Diseases; Psoas Muscles; Rifampin; Therapeutic Irrigation

Perforating ulcers of the foot occurring in leprosy are frequent, chronic, often giving mutilations. They usually affect the adult. Plantar ulcer occurred in a 15 year-old young patient affected by tuberculoid leprosy has incited us to report it.

Topics: Adolescent; Anti-Bacterial Agents; Bone Diseases; Dapsone; Drug Therapy, Combination; Female; Foot; Foot Deformities, Acquired; Foot Ulcer; Hand Deformities, Acquired; Humans; Hypesthesia; Leprosy, Tuberculoid; Rifampin

Rifampin, which exhibits good intracellular diffusion and in vitro bactericidal activity on brucella, is effective in experimental brucellosis in mice, without selection of resistant strains. It was therefore legitimate to use rifampin in man since conventional treatment of acute brucellosis is followed by recurrence in 15% (tetracycline alone) or 3.7% (streptomycin-tetracycline combination) of cases. Rifampin was given to 13 patients with brucellosis (acute brucellosis in 8, osteoarticular brucellosis in 3 and chronic brucellosis in 2). Rifampin was given as sole therapy in a daily dosage of 600 to 1 200 mg. A tetracycline was subsequently needed in three cases, in combination with rifampin in two, and as replacement therapy in one. Treatment lasted 20 to 60 days in acute brucellosis and 2 to 15 months in other forms. Only one failure was recorded among the 11 cases of acute or localized brucellosis. Conversely, effectiveness of rifampin proved incomplete (1 case) or null (1 case) in chronic forms. The satisfactory effectiveness of rifampin is confirmed by a review of the literature which found 17 reports addressing the subject. These include 324 cases of brucellosis treated by rifampin, as sole therapy in 255 patients, with only 24 failures ascribable to faulty dosage. Indeed, rifampin must be given for at least 30 days, in a minimal daily dosage of 600 mg or 10 mg per kg, in a single dose. Cotrimoxazole is an antagonist and should not be associated with rifampin. Conversely, tetracyclines are synergistic and their association, which is useless in acute brucellosis, is helpful in localized and chronic forms.

Topics: Acute Disease; Adult; Aged; Bone Diseases; Brucellosis; Chronic Disease; Doxycycline; Drug Therapy, Combination; Female; Humans; Joint Diseases; Male; Middle Aged; Rifampin; Sepsis

A white child with a long history of illness from the age of six was thought at first to have Hodgkin's disease. There followed an acute illness with lesions involving glands, lungs, bone and skin. Mycobacterium avium-intracellulare group (Battey) was isolated from various lesions at the age of thirteen. After six years of continuous treatment the patient, now eighteen, is living a normal life.

Topics: Adolescent; Bone Diseases; Bone Neoplasms; Child; Diagnosis, Differential; Ethambutol; Hodgkin Disease; Humans; Isoniazid; Kanamycin; Male; Mycobacterium; Mycobacterium avium; Mycobacterium Infections; Radiography; Rifampin; Time Factors

Topics: Adolescent; Adult; Bone Diseases; Child; Child, Preschool; Evaluation Studies as Topic; Female; Fistula; Humans; Infant; Male; Rifampin; Tuberculosis, Osteoarticular

Topics: Adolescent; Adult; Bone Diseases; Central Nervous System Diseases; Female; Humans; Injections, Spinal; Male; Middle Aged; Neurosurgery; Pneumococcal Infections; Rifampin; Skin Diseases; Staphylococcal Infections