rifampin and Heroin-Dependence

Topics: Adult; Aged; Chromatography, Gas; Drug Interactions; Feces; Female; Heroin Dependence; Humans; Liver; Male; Mass Spectrometry; Methadone; Methods; Middle Aged; Naloxone; Rifampin; Substance Withdrawal Syndrome; Tuberculosis, Pulmonary

Topics: Adult; Drug Interactions; Heroin Dependence; Humans; Male; Methadone; Rifampin; Substance Withdrawal Syndrome; Tuberculosis, Cutaneous

Wangiella dermatitidis is an infrequently encountered dematiacious fungus that usually causes localized infections of the skin and subcutaneous tissues. This report presents the first well-documented case of natural valve infection caused by this organism as it occurred in intravenous drug abuser. His course has been complicated by relapsing infection of two aortic prostheses and dissemination to the vertebral spine. Treatment with a combination of amphotericin B, rifampin, and ketoconazole has arrested the progression of his infection. The microbiologic features and existing clinical information regarding this fungus are reviewed and in vitro susceptibility data for the present isolate are presented.

Topics: Adult; Amphotericin B; Aortic Valve; Drug Therapy, Combination; Endocarditis; Heart Valve Diseases; Heroin Dependence; Humans; Ketoconazole; Male; Mitosporic Fungi; Mycoses; Recurrence; Reoperation; Rifampin

Staphylococcal endocarditis is a condition affecting intravenous drug abusers at increasing rates, and its treatment is still controversial. We used, successfully, high doses of rifampicin, associated with an aminoglycoside, for the treatment of two heroin addicts. In the first we found a left-sided endocarditis with metastatic abscesses in brain, both kidneys, liver and spleen; in the other the finding of bilateral lung abscesses was related to embolic episodes from a diseased tricuspid valve. Since the isolated strains of Staphylococcus aureus were tolerant to methicillin, we used oral rifampicin (20 mg/kg/day) plus an aminoglycoside (amikacin in the former and gentamicin in the latter), after in-vitro testing had proved these combinations to be effective. We achieved, in both cases stable bactericidal concentrations in the serum and a lasting clinical recovery.

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heroin Dependence; Humans; Methicillin; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections

Topics: Adolescent; Female; Heroin Dependence; Humans; Injections, Intravenous; Peritonitis; Pneumonia, Staphylococcal; Rifampin; Staphylococcal Infections; Vancomycin

The results are reported of a service in Hong Kong of intensive antituberculosis chemotherapy with 5 drugs given daily for 4 months, or until discharge from hospital or release from prison if earlier, in the treatment of male Chinese drug addicts and prisoners who had pulmonary tuberculosis positive for acid-fast bacilli on microscopic examination of the sputum. Of 69 patients who received 4 months of chemotherapy, all those with sputum cultures negative for M. tuberculois initially, and more than 80% of those with positive cultures, 41% of whom had strains resistant to isoniazid, streptomycin, or both drugs, achieved quiescent disease, which was maintained for a year of follow-up. Some of the patients who received less than 4 months of chemotherapy also reponded well. Despite the 5 drugs, the frequency of adverse reactions to the regimen was low.

Topics: Antitubercular Agents; Drug Administration Schedule; Drug Resistance, Microbial; Ethambutol; Heroin Dependence; Hong Kong; Humans; Isoniazid; Male; Opioid-Related Disorders; Opium; Prisoners; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis; Tuberculosis, Pulmonary

Topics: Adult; Aged; Drug Interactions; Heroin Dependence; Humans; Isoniazid; Male; Methadone; Middle Aged; Rifampin; Substance Withdrawal Syndrome; Tuberculosis, Pulmonary