rifampin and Deglutition-Disorders

Topics: Aged; Antitubercular Agents; Deglutition Disorders; Delayed Diagnosis; Diagnosis, Differential; Directly Observed Therapy; Endoscopy, Digestive System; Esophageal Neoplasms; Esophagitis; Ethambutol; Fever; Humans; Isoniazid; Lymph Nodes; Lymphadenopathy; Male; Mexican Americans; Pyrazinamide; Rifampin; Substance-Related Disorders; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; Ultrasonography

It is not always possible to administer antituberculosis pharmacotherapy orally for reasons that may be a direct consequence of tuberculosis itself. To our knowledge, no published literature is available regarding antituberculosis drug absorption via feeding tube. We present the case of a patient with tuberculosis meningitis who required medication administration via percutaneous endoscopic jejunostomy (PEJ) tube. Blood samples were collected during the continuation phase of antituberculosis therapy, immediately before dose administration, and then at 1, 2, 4, and 6 hours after dose administration for quantification of serum rifampin concentrations. Assaying these concentrations by high-pressure liquid chromatography demonstrated a peak serum rifampin level (C(max)) of 18 μg/ml and total rifampin exposure (area under the curve from 0-6 hours [AUC(0-6)]) of 50.1 μg/ml. These are high compared with rifampin C(max) and AUC(0-6) values reported in patients after oral rifampin administration; C(max) tends to range between 4.0-10.5 μg/ml and AUC(0-6) 7.0-52.9 μg/ml after oral administration of 600 mg at steady state. Based on our patient's results, therefore, rifampin administered by PEJ tube appears to be well absorbed, with preservation of adequate C(max) and AUC values. It is worth noting that this was in the context of drug administration in the fasted state. In the absence of any published evidence of adequate absorption via jejunal feeding tube in the nonfasted state, it would seem prudent to ensure that patients are fasted when rifampin is administered via PEJ tube, just as patients are when oral rifampin is administered. This report represents the first documented evidence, to our knowledge, of adequate rifampin absorption when administered via PEJ tube and provides important reassurance for health care providers, patients, and families facing similar clinical scenarios.

Topics: Administration, Mucosal; Antibiotics, Antitubercular; Deglutition Disorders; Endoscopy, Gastrointestinal; Humans; Intestinal Absorption; Intestinal Mucosa; Jejunostomy; Jejunum; Male; Middle Aged; Rifampin; Tuberculosis, Meningeal

Topics: Antitubercular Agents; Biopsy; Combined Modality Therapy; Deglutition Disorders; Drainage; Ethambutol; Goiter; Hormone Replacement Therapy; Humans; Hypothyroidism; Isoniazid; Lymphatic Diseases; Male; Middle Aged; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Pyrazinamide; Rifampin; Thyroiditis; Thyroxine; Tuberculosis, Endocrine

Multidrug-resistant tuberculosis is increasing worldwide. The determination of possible resistance is essential for adequate treatment. Tuberculosis is common amongst immigrants from Somalia and extra-pulmonary localisation is often seen.. A 21-year-old woman from Somalia presented with progressive dysphagia and severe weight loss. Endoscopy revealed two ulcers in the mid-oesophagus. A chest x-ray showed enlarged lymph nodes in the right hilar and mediastinal regions. The Ziehl-Neelsen stain and PCR for mycobacteria were negative. Sputum samples and oesophageal biopsies were cultured. Quadruple tuberculostatic therapy was started empirically. After five weeks, a sputum culture grew Mycobacterium tuberculosis, which was resistant to rifampicin and isoniazid. She was treated with second-line anti-tuberculous therapy and eventually recovered.. Tuberculosis can manifest in many ways. It is important to obtain patient material for culture; not only to confirm the diagnosis but also for the determination of possible resistance which is necessary for adequate therapy.

Topics: Antitubercular Agents; Deglutition Disorders; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Netherlands; Rifampin; Somalia; Tuberculosis, Multidrug-Resistant; Young Adult

The AA. present a report about a patient having a cold tuberculous abscess which symptomatologic manifested through dysphagia and cervico-brachialgia. Comments on the most remarkable aspects of these conditions.

Topics: Abscess; Brachial Plexus Neuritis; Deglutition Disorders; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Middle Aged; Neck; Rifampin; Tuberculosis