rifampin and Hepatic-Encephalopathy

Rifaximin is a rifamycin analogue with a broad spectrum of activity similar to that of rifampin; however, because it is poorly absorbed in the gastrointestinal tract, the focus of its development has been on intestinal infections and diseases. This agent has proven to be as effective as ciprofloxacin in treating travelers' diarrhea due to Escherichia coli, although it is ineffective in treating infections due to Campylobacter jejuni. Other potential uses for rifaximin in gastroenterologic disorders include treatment of hepatic encephalopathy, intestinal gas and gas-related symptoms, diverticular disease, intestinal bacterial overgrowth, pouchitis, ulcerative colitis, and active Crohn's disease. This article highlights several studies demonstrating the efficacy of rifaximin in treating travelers' diarrhea as well as other gastrointestinal diseases and discusses the drug's pharmacokinetics, indications, contraindications, warnings, precautions, adverse reactions, and dosing.

Topics: Anti-Infective Agents; Diarrhea; Escherichia coli Infections; Gases; Hepatic Encephalopathy; Humans; Inflammatory Bowel Diseases; Intestinal Absorption; Intestines; Lactulose; Microbial Sensitivity Tests; Rifampin; Rifamycins; Rifaximin

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Drug Therapy, Combination; Female; Hepatic Encephalopathy; Humans; Isoniazid; Pyrazinamide; Rifampin; Tuberculosis, Meningeal

Two patients with liver failure secondary to isoniazid hepatotoxicity were successfully treated with orthotopic liver transplantation. A 49-year-old man received isoniazid prophylaxis for a positive tuberculin test, and a 60-year-old woman was treated for active pulmonary tuberculosis with isoniazid, rifampin, and pyrazinamide. Both patients developed hepatic failure 4 and 1.5 months after initiation of antituberculous drug therapy, respectively. Liver transplantation was performed for progressive hepatic failure and was successful in both patients. The patient with active pulmonary tuberculosis was successfully treated with a modified antituberculous drug regimen while taking standard doses of immunosuppressive drugs after transplantation. In conclusion, liver transplantation is feasible and effective therapy for patients with isoniazid-induced hepatic failure, and active pulmonary tuberculosis may represent a relative rather than absolute contraindication to transplantation.

Topics: Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Female; Hepatic Encephalopathy; Humans; Isoniazid; Liver Failure; Liver Transplantation; Male; Middle Aged; Rifampin; Tuberculosis, Pulmonary

Topics: Aged; Anti-Bacterial Agents; Contraindications; Daptomycin; Disease Progression; Drug Substitution; Echocardiography, Transesophageal; Endocarditis; Fatal Outcome; Fluid Therapy; Hepatic Encephalopathy; Hepatorenal Syndrome; Humans; Kidney Function Tests; Liver Transplantation; Male; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Staphylococcus lugdunensis; Vancomycin

Topics: Acetaminophen; Adult; Analgesics, Non-Narcotic; Antibiotics, Antitubercular; Drug Interactions; Female; Hepatic Encephalopathy; Humans; Rifampin

Hepatotoxicity by antituberculous drugs is well known. Nonetheless, severe liver involvement is infrequent. Several series of fulminant hepatitis by antituberculous drugs have recently been reported with a much greater frequency than previously reported. The present study describes the authors' experience which, similar to other groups, has shown a marked increase with respect to previous experience. During 1994 5 patients with acute severe hepatitis associated to antituberculous drugs were admitted to the authors' unit. The mean age of the patients was 43 years (range: 25-62). Two patients were healthy HBsAg carriers, one undergoing enzymatic inducer treatment and was anti-HIV positive. Another patient presented compensated liver cirrhosis by HCV. The 5 cases received combined isoniazid and rifampicin and four had also received pyrazinamide. Four patients presented hepatic encephalopathy. Of these cases, three could not undergo emergency liver transplantation because of contraindications and died due to complications of acute severe liver failure. Another patient evolved favorably following emergency liver transplantation. The only patient who presented good evolution with conservative treatment and who did not present hepatic encephalopathy had discontinued isoniazid because of the finding of slight hypertransaminasemia during a routine analytical control. Several risk factors have been reported for the appearance of hepatotoxicity by antituberculous drugs. The factor of greatest clinical importance for the development of severe hepatotoxicity is probably continuation of the treatment once hepatic dysfunction has initiated. The important increase in cases of severe toxicity urges the need for strict analytical monitoring following initiation of treatment.

Topics: Acute Disease; Adult; Antibiotics, Antitubercular; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Female; Hepatic Encephalopathy; Humans; Isoniazid; Liver; Liver Failure; Liver Transplantation; Male; Middle Aged; Pyrazinamide; Rifampin

Topics: Amino Acid Metabolism, Inborn Errors; Biliary Atresia; Child; Child, Preschool; Contraindications; Drug Interactions; Erythromycin; Female; Hepatic Encephalopathy; Humans; Liver Transplantation; Male; Propionates; Rifampin; Tacrolimus

Isoniazid and pyrazinamide are well-known hepatotoxic drugs, often used in combination. The aim of this study was to assess the prognostic influence of pyrazinamide on the outcome of fulminant or subfulminant liver failure caused by antituberculous therapy. Eighteen patients with fulminant or subfulminant liver failure due to antituberculous therapy were studied. Nine patients received isoniazid and rifampicin without pyrazinamide (group 1), and nine patients received isoniazid and rifampicin together with pyrazinamide (group 2). The severity of fulminant and subfulminant liver failure, as judged by the prevalence of coma and the lowest level of factor V, was similar in the two groups. Spontaneous survival was greater in group 1 (eight of nine) than in group 2 (two of nine) (P < .02). The authors conclude that pyrazinamide co-administration was associated with an increased mortality in patients with fulminant or subfulminant hepatitis occurring during antituberculous therapy. In these patients, pyrazinamide administration and an interval of more than 15 days between the onset of antituberculous treatment and jaundice, combined with grade III encephalopathy and factor V below 20%, predicted death without liver transplantation.

Topics: Adolescent; Adult; Aged; Drug Therapy, Combination; Female; Hepatic Encephalopathy; Humans; Isoniazid; Liver Transplantation; Male; Middle Aged; Pyrazinamide; Rifampin; Survival Rate

The incidence of tuberculosis has been increasing since 1987, exposing a greater number of patients to the risks of three potentially hepatotoxic drugs, isoniazid, rifampicin, and pyrazinamide. Awareness of potentially severe drug hepatotoxic reactions is vital because fulminant hepatic failure is a devastating and often fatal condition without liver transplantation. We report four cases of fulminant hepatic failure caused by rifampicin, isoniazid, or both. These cases highlight the need for stricter adherence to and review of current guidelines on liver function tests after starting anti-tuberculous therapies.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Female; Hepatic Encephalopathy; Humans; Immunosuppression Therapy; Isoniazid; Liver Function Tests; Liver Transplantation; Male; Middle Aged; Rifampin; Tuberculosis, Lymph Node; Tuberculosis, Pulmonary

Topics: Aged; Aged, 80 and over; Chemical and Drug Induced Liver Injury; Fatal Outcome; Female; Hepatic Encephalopathy; Humans; Isoniazid; Rifampin; Risk Factors

The delphi method of decision making was used to address an unusual clinical case in which various aspects of the case required opposing management strategies.. A panel of 30 pulmonary experts was surveyed repeatedly until a convergence of treatment approaches was reached for a patient who was considered to have both a universal indication for and a universal contraindication against prevention therapy. Participants were asked to evaluate the appropriateness of proposed treatments on a scale from 1 to 9, with 1 being extremely inappropriate, 5 being equivocal, and 9 being extremely appropriate. The delphi survey data responses were compared using measures of central tendency (ie, the mean and median) and measures of variability (ie, the standard deviation and interquartile range).. Although no treatment was wholeheartedly supported by the experts, analysis of the three-round delphi survey responses resulted in two possible treatments: rifampin, 600 mg daily, for four months, or no treatment with close observation. Interestingly, the experts working in a non-university setting favored the rifampin treatment, and those working in a university setting favored no treatment with close observation.. The delphi method has the potential to be used for clinical decision making.

Topics: Adult; Contraindications; Delphi Technique; Drug Therapy, Combination; Ethambutol; Female; Hepatic Encephalopathy; Humans; Isoniazid; Liver Transplantation; Rifampin; Time Factors; Tuberculosis, Pulmonary

A 58-year-old woman with tuberculosis received antituberculous drugs which included isoniazid, rifampicin, and ethambutol. Nausea and anorexia were initial symptoms while jaundice and abdominal pain were late manifestations. She became comatose and died 7 weeks after therapy. Autopsy revealed submassive necrosis of the liver and active advanced pulmonary tuberculosis. It is, thus, necessary for the physician to be alert for this serious complication in prescribing a combination of these antituberculous drugs.

Topics: Chemical and Drug Induced Liver Injury; Female; Hepatic Encephalopathy; Humans; Isoniazid; Liver; Middle Aged; Necrosis; Rifampin

Topics: Anticonvulsants; Chemical and Drug Induced Liver Injury; Drug Interactions; Hepatic Encephalopathy; Humans; Isoniazid; Liver; Male; Middle Aged; Necrosis; Rifampin

Topics: Adult; Carbamazepine; Female; Hepatic Encephalopathy; Humans; Isoniazid; Liver; Necrosis; Rifampin

Topics: Adult; Chemical and Drug Induced Liver Injury; Drug Therapy, Combination; Epilepsy; Female; Hepatic Encephalopathy; Humans; Isoniazid; Phenobarbital; Rifampin; Tuberculosis, Miliary

Topics: Child; Hepatic Encephalopathy; Humans; Isoniazid; Male; Rifampin; Tuberculosis, Pulmonary

Topics: Aged; Female; Hepatic Encephalopathy; Humans; Jaundice; Liver Cirrhosis; Male; Rifampin

A case report is given on two patients receiving halothane anesthesia while beeing treated with isoniacid, ethambutol and rifampicin. Following halothane anesthesia, both patients developed a severe liver disease with encephalopathy grade III. We observed a moderate increase of bilirubin and SGOT and a more severe increase of serum ammonia. Histologically, both patients had alterations compatible with drug hepatitis. Within 14 days remission occurred spontaneously. The two case reports do not fit with typical isoniacid hepatitis or typical halothane hepatitis. The possibility of combined drug toxicity on liver during halothane and isocianid treatment is discussed.

Topics: Adult; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Ethambutol; Female; Halothane; Hepatic Encephalopathy; Humans; Isoniazid; Middle Aged; Rifampin; Time Factors

Topics: Adolescent; Chemical and Drug Induced Liver Injury; Hepatic Encephalopathy; Humans; Isoniazid; Liver; Liver Function Tests; Male; Rifampin; Tuberculosis, Pleural; Tuberculosis, Pulmonary

Topics: Aged; Chemical and Drug Induced Liver Injury; Hepatic Encephalopathy; Humans; Male; Rifampin; Tuberculosis, Pulmonary