rifampin and Headache

Tuberculosis is a global burden with an unacceptably high mortality rate, especially in low- and middle-income countries. We reported the case of 34-year-old Somali female with no significant risk factors who initially presented with headache and blurred vision. The patient subsequently developed altered mental status and significant vision changes. Initial lumbar puncture showed lymphocytic pleocytosis with negative gram stain, acid-fast bacilli stain, and culture. Initial polymerase chain reaction for tuberculosis was negative. The patient worsened despite receiving broad-spectrum antibiotics. The patient had a prolonged hospital course and eventually required lumbar drain placement for hydrocephalus. Repeated polymerase chain reactions for Mycobacterium tuberculosis from the lumbar drain samples was positive, and the diagnosis of tuberculous meningitis was confirmed. The patient improved after lumbar drain placement and treatment with isoniazid, rifampin, pyrazinamide, ethambutol and steroid tapering. This case illustrated the challenge of diagnosing tuberculous meningitis.

Topics: Adult; Antitubercular Agents; Asthma; Ethambutol; Female; Headache; Hospitalization; Humans; Hydrocephalus; Isoniazid; Leukocytosis; Magnetic Resonance Imaging; Polymerase Chain Reaction; Pyrazinamide; Rifampin; Somalia; Spinal Puncture; Tuberculosis, Meningeal; United States; Vision Disorders

Although cytochrome P450 (CYP) 2D6 is often thought to be the only CYP responsible for the metabolism of risperidone, many reports suggest that CYP3A may be involved too. Rifampin, a potent CYP3A inducer, has been known to markedly decrease plasma concentrations of various drugs, which are concomitantly administered during treatment.. To examine the effect of rifampin on plasma concentrations of a single oral dose of risperidone in healthy Thai male volunteers.. In an open, randomized two-phase crossover study, separated by a 2-week period, 10 healthy Thai male volunteers received a single oral dose of 4-mg risperidone alone or with 600 mg rifampin, orally once daily for 5 days. Serial blood samples were collected at specific time points for a 48-h period. Risperidone was measured in plasma using high performance liquid chromatography with ultraviolet detection. Pharmacokinetic parameters were determined by using non-compartmental analysis.. Co-administration with 600-mg rifampin once daily for 5 days was associated with a significant decrease in risperidone area under the curve (AUC(0-48)) and maximal concentration (C(max)) by 72% (157 x 49 +/- 48 x 80 vs. 42 x 66 +/- 7 x 81 ng/L/h; P<0 x 01) and 50% (32 x 44 +/- 6 x 05 vs. 16 x 16 +/- 2 x 73 ng/mL; P<0 x 05), respectively when compared with risperidone alone.. Rifampin when used concurrently with risperidone significantly decreases the plasma concentration of risperidone. Our results provide in vivo evidence of the involvement of CYP3A in the metabolism of risperidone, in addition to CYP2D6. Thus, co-administration of risperidone with CYP3A inducer(s), including rifampin should be recognized or avoided in clinical practice.

Topics: Administration, Oral; Adult; Antibiotics, Antitubercular; Antipsychotic Agents; Area Under Curve; Capsules; Chromatography, High Pressure Liquid; Cross-Over Studies; Cytochrome P-450 CYP3A; Cytochrome P-450 Enzyme System; Dizziness; Drug Interactions; Half-Life; Headache; Humans; Male; Nasal Obstruction; Rifampin; Risperidone; Spectrophotometry, Ultraviolet; Tablets; Time Factors

Topics: Clinical Trials as Topic; Drug Therapy, Combination; Female; Fever; Gastrointestinal Diseases; Headache; Humans; Isoniazid; Male; Purpura, Thrombocytopenic; Rifampin; Time Factors; Tuberculosis, Pulmonary

Topics: Adult; Animals; Antibody Formation; Antigen-Antibody Reactions; Clinical Trials as Topic; Female; Fever; Headache; Humans; Immune Tolerance; Male; Mice; Middle Aged; Purpura, Thrombocytopenic; Rabbits; Rats; Rifampin; Tuberculosis, Pulmonary

Efavirenz (EFV) therapeutic response and toxicity are associated with high inter-individual variability attributed to variation in its pharmacokinetics. Plasma concentrations below 1 μg/ml may result in virologic failure and above 4 μg/ml, may result in central nervous system adverse effects. This study used population pharmacokinetics modeling to explore the influence of demographic and pharmacogenetic factors including efavirenz-rifampicin interaction on EFV pharmacokinetics, towards safer dosing of EFV.. Patients receiving an EFV-based regimen for their antiretroviral therapy and a rifampicin-containing anti-TB regimen were recruited. EFV plasma concentrations were measured by HPLC and genomic DNA genotyped for variants in the CYP2B6, CYP2A6 and ABCB1 genes. All patients were evaluated for central nervous system adverse effects characterised as sleep disorders, hallucinations and headaches using the WHO ADR grading system. A pharmacokinetic model was built in a forward and reverse procedure using nonlinear mixed effect modeling in NONMEM VI followed by model-based simulations for optimal doses.. CYP2B6*6 and *18 variant alleles, weight and sex were the most significant covariates explaining 55% of inter-individual variability in EFV clearance. Patients with the CYP2B6*6TT genotype had a 63% decrease in EFV clearance despite their CYP2B6*18 genotypes with females having 22% higher clearance compared to males. There was a 21% increase in clearance for every 10 kg increase in weight. The effect of TB/HIV co-treatment versus HIV treatment only was not statistically significant. No clinically relevant association between CYP2B6 genotypes and CNS adverse effects was seen, but patients with CNS adverse effects had a 27% lower clearance compared to those without. Model- based simulations indicated that all carriers of CYP2B6*6 TT genotype would be recommended a dose reduction to 200 mg/day, while the majority of extensive metabolisers may be given 400 mg/day and still maintain therapeutic levels.. This study showed that screening for CYP2B6 functional variants has a high predictability for efavirenz plasma levels and could be used in prescribing optimal and safe EFV doses.

Topics: Acquired Immunodeficiency Syndrome; Adult; Alkynes; Alleles; Anti-HIV Agents; ATP Binding Cassette Transporter, Subfamily B; Benzoxazines; Body Weight; Case-Control Studies; Cyclopropanes; Cytochrome P-450 CYP2A6; Cytochrome P-450 CYP2B6; Drug Interactions; Female; Hallucinations; Headache; Humans; Male; Models, Biological; Rifampin; Sex Characteristics; Sleep Wake Disorders; Tuberculosis; Zimbabwe

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cervical Vertebrae; Clindamycin; Drug Therapy, Combination; Embolism; Female; Gram-Positive Bacterial Infections; Headache; Humans; Lemierre Syndrome; Myalgia; Peptostreptococcus; Retropharyngeal Abscess; Rifampin; Spondylitis; Tomography, X-Ray Computed; Young Adult

We report the first known Australian case of probable neurobrucellosis, in a young feral-pig shooter who presented with episodic left-sided visual loss and left-sided numbness and headache. Treatment with intravenous ceftriaxone and oral rifampicin, doxycycline and trimethoprim–sulfamethoxazole resulted in a good clinical response.

Topics: Adult; Agglutination Tests; Agricultural Workers' Diseases; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Australia; Brucella; Brucellosis; Ceftriaxone; Central Nervous System Bacterial Infections; Doxycycline; Drug Therapy, Combination; Headache; Humans; Hypesthesia; Male; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination; Vision Disorders

Brain abscesses are a rare but potentially lethal neurological lesions, generally occurring after septic episodes in immunodeficient patients or complicating neurosurgical procedures. Even though they are known complications of surgically treated intracerebral haemorrhages (ICH), the presence of a brain abscess at the site of an untreated ICH is a rare event. Such cases may result from haematogenous spread from distant foci or contiguous sites and are often preceded by episodes of sepsis and local infection. Immunodeficiency, AIDS, age, diabetes mellitus and vitamin-K deficiency are predisposing factors. Abscess formation should be considered in case of clinical deterioration, headache, and any neurological deficit after febrile episodes. Early diagnosis with neuroradiological imaging, infection blood markers and microbiological identification of the causative pathogen is crucial for treatment with surgical drainage or excision and specific antibiotic therapy, which guarantee good outcome and long-term survival. In fact, while prompt diagnosis and treatment guarantee good outcome and long-term survival, morbidity and mortality are very high in case of misdiagnosis. We report a case of a 49-year old man presenting with a brain abscess 13 weeks after a spontaneous ICH, without previous episodes of sepsis and with a suspected septic arthritis 2 weeks after abscess drainage.

Topics: Anti-Bacterial Agents; Brain Abscess; Cerebral Hemorrhage; Chemoradiotherapy; Drainage; Dysarthria; Headache; Hodgkin Disease; Humans; Hypertension; Levofloxacin; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nervous System Diseases; Oxacillin; Rifampin; Spine; Tomography, X-Ray Computed; Treatment Outcome

Brucellosis is prevalent in North and East Africa, the Middle East, South and Central Asia, South and Central America and the Mediterranean countries of Europe. In 5% of cases it may lead to central nervous system manifestation presenting most often as a meningitis or meningoencephalitis. Here we report and discuss a case of neurobrucellosis with meningitis with cranial nerves neuritis. A 56-year-old German male was admitted with bilateral abducens nerve palsy, amblyacousia and intractable headaches. An enzyme-linked immunosorbent assay (ELISA) revealed antibodies against Brucella in serum and cerebrospinal fluid (CSF). Additionally, our patient suffered from an infarction of the left thalamus. In conclusion, in cases of unresponsive meningitis or meningoencephalitis and history of travel in endemic regions, neurobrucellosis should be considered. If initial microbiological tests fail, complementary investigations such as ELISA are indicated to detect Brucella species in serum and/or CSF.

Topics: Abducens Nerve Diseases; Anti-Bacterial Agents; Anti-Inflammatory Agents; Brain Infarction; Brucella; Brucellosis; Cranial Nerve Diseases; Doxycycline; Headache; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Methylprednisolone; Middle Aged; Rifampin; Thalamic Diseases; Treatment Outcome

Topics: Adolescent; Agglutination Tests; Anti-Bacterial Agents; Brucellosis; Cerebrospinal Fluid; Diplopia; Headache; Humans; Male; Paraplegia; Polyradiculoneuropathy; Prednisone; Rifampin; Rose Bengal

Topics: Adult; Antigen-Antibody Complex; Drug Hypersensitivity; Female; Fever; Headache; Humans; Leprosy; Male; Nausea; Rifampin; Syndrome; Vomiting

Three patients with verified intracranial tuberculomas are reported. One patient presented with attacks of hydrocephalus initially diagnosed erroneously as migraine, another had multiple tuberculomas and a fourth tuberculoma became apparent during treatment with antituberculous therapy. The third patient presented with a frontal lobe syndrome and the postoperative recovery was complicated by the development of hyperosmolar non-ketotic, non-acidotic diabetic pre-coma. Although there are no pathognomonic symptoms, signs, or radiological appearances of intracranial tuberculomas, a high index of suspicion should always be entertained during the investigation of non-European immigrants.

Topics: Adolescent; Aminosalicylic Acids; Brain Diseases; Dexamethasone; Diabetic Coma; Electroencephalography; Emigration and Immigration; Ethambutol; Female; Headache; Humans; Hydrocephalus; India; Isoniazid; Male; Papilledema; Pyrazinamide; Radionuclide Imaging; Rifampin; Streptomycin; Technetium; Tuberculoma; United Kingdom

Topics: Aged; Aminosalicylic Acids; Diarrhea; Drug Resistance, Microbial; England; Ethambutol; Headache; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Rifampin; Sputum; Streptomycin; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Adolescent; Cycloserine; Drug Therapy, Combination; Dyspnea; Ethambutol; Ethionamide; Fever; Follow-Up Studies; Headache; Humans; Purpura, Thrombocytopenic; Pyrazinamide; Rifampin; Time Factors; Tuberculosis, Pulmonary

Topics: Antibody Formation; Antigen-Antibody Reactions; Drug Therapy, Combination; Fever; Headache; Humans; Isoniazid; Nausea; Purpura, Thrombocytopenic; Pyridoxine; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Ambulatory Care; Drug Therapy, Combination; Ethambutol; Female; Headache; Humans; Male; Nausea; Purpura, Thrombocytopenic; Rifampin; Tuberculosis, Pulmonary; Vomiting

Topics: Drug Therapy, Combination; Ethambutol; Fever; Headache; Humans; Isoniazid; Kidney Diseases; Rifampin; Streptomycin; Time Factors; Tuberculosis, Pulmonary

Topics: Body Weight; Drug Therapy, Combination; Ethambutol; Female; Fever; Headache; Humans; Male; Nausea; Pain; Purpura, Thrombocytopenic; Rifampin; Time Factors; Tuberculosis, Pulmonary; Vomiting

Topics: Acute Kidney Injury; Antibodies; Drug Therapy, Combination; Ethambutol; Fever; Headache; Hemorrhage; Humans; Liver Function Tests; Nausea; Purpura, Thrombocytopenic; Rifampin; Time Factors; Tuberculosis, Pulmonary

Topics: Aminocaproates; Asthenia; Drug Hypersensitivity; Female; Fever; Gastrointestinal Diseases; Headache; Humans; Middle Aged; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary; Vertigo

Topics: Chronic Disease; Coma; Dactinomycin; Daunorubicin; Dexamethasone; Encephalomyelitis; Fever; Headache; Humans; Idoxuridine; Leukopenia; Meningitis, Viral; Mental Disorders; Pain; Paralysis; Respiratory Insufficiency; Rifampin; Vomiting