rifampin and Kidney-Failure--Chronic

Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3-4 month isoniazid plus rifampicin; or 3-4 month rifampicin alone.

Topics: Antirheumatic Agents; Antitubercular Agents; Coinfection; Comorbidity; Disease Management; Drug Users; Emigrants and Immigrants; Evidence-Based Medicine; Health Personnel; HIV Infections; Humans; Ill-Housed Persons; Interferon-gamma Release Tests; Isoniazid; Kidney Failure, Chronic; Latent Tuberculosis; Mass Screening; Practice Guidelines as Topic; Prisoners; Public Health; Radiography, Thoracic; Renal Dialysis; Rifampin; Risk Assessment; Silicosis; Substance-Related Disorders; Transplant Recipients; Tuberculin Test; Tumor Necrosis Factor-alpha; World Health Organization

Topics: Aged; Aminosalicylic Acids; Capreomycin; Chemical Phenomena; Chemistry; Color Perception; Drug Therapy, Combination; Ethambutol; Eye; Eye Diseases; Female; Humans; Isoniazid; Kidney Failure, Chronic; Male; Middle Aged; Rifampin; Tuberculosis, Pulmonary; Visual Acuity; Visual Fields

Screening for and treatment of latent tuberculosis (TB) in patients with end-stage kidney disease (ESKD) are recommended. However, there is limited evidence on safety and treatment completion in this population. The objective of the study is to evaluate three short-course rifamycin-based regimens for the treatment of latent TB in ESKD patients.. Study design and setting. This is a prospective, open label, randomized clinical trial, that will be conducted at seven teaching hospitals in Spain. Study population, randomization, and interventions. Consecutive adult patients with ESKD requiring treatment for a latent TB infection will be randomly allocated (1:1:1) to receive one of the three treatment regimens of the study: three months of daily isoniazid plus rifampicin (3HR); three months of once-weekly isoniazid plus rifapentine (3HP); or four months of daily rifampicin (4R). Participants will be followed regularly through pre-established visits and a blood test schedule from enrolment to a month after finishing the assigned treatment. Outcomes. The primary outcome will be treatment completion, while the secondary outcomes will be discontinuation of the assigned treatment due to adverse events, related or unrelated to the study treatment; definitive discontinuation of the assigned treatment because of adverse events related to the treatment of the study, and death. Sample size. Two hundred and twenty-five subjects (75 per arm) will be enrolled, which will enable the demonstration, if it exists, of an increase of 0.16 in treatment completion rates either in the 3HP or 4R arm with respect to the 3HR arm.. Results of this clinical trial will contribute to evidence-based recommendations on the management of latent TB infection in ESKD patients.. ClinicalTrials.gov identifier: NCT05021731.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Humans; Isoniazid; Kidney Failure, Chronic; Latent Tuberculosis; Prospective Studies; Randomized Controlled Trials as Topic; Rifampin

The cytochrome p450 (CYP) oxidative enzyme system, located primarily in the liver and small intestine, is responsible for metabolism and detoxification of numerous endogenous and exogenous substances. The most abundant CYP enzyme, CYP3A, is known to be involved in the metabolism of more than 200 commonly used medications. In experimental models of renal failure, both hepatic function and CYP enzyme content are reduced; however, direct evidence in humans is lacking. Evaluation of drug metabolism in patients with end-stage renal disease is important because these patients use a large number of medications and are at risk of adverse reactions and drug-drug interactions.. We measured hepatic CYP3A activity at baseline and after rifampin (INN, rifampicin) enzyme induction in 12 patients with end-stage renal disease and 12 healthy, age-matched controls. Hepatic CYP3A phenotype was characterized with the erythromycin breath test, and enzyme induction capacity was evaluated with a short course of rifampin (600 mg/d for 6 days).. The end-stage renal disease group had 28% lower baseline erythromycin breath test values than controls (P <.05); however, enzyme induction capacity after rifampin administration was similar between groups (P =.70).. The findings suggested that one mechanism by which patients with end-stage renal disease are at increased risk of drug toxicity is reduced activity of the CYP3A enzyme pathway.

Topics: Adult; Aged; Antibiotics, Antitubercular; Aryl Hydrocarbon Hydroxylases; Breath Tests; Cytochrome P-450 CYP3A; Enzyme Induction; Erythromycin; Female; Humans; Kidney Failure, Chronic; Liver; Male; Middle Aged; Oxidoreductases, N-Demethylating; Phenotype; Prospective Studies; Protein Synthesis Inhibitors; Rifampin

Tuberculosis was diagnosed in 26 patients (6 females and 20 males) undergoing maintenance hemodialysis, with an incidence of 23.6%. Infection was characterized clinically by a very insidious onset, the main symptoms being anorexia, loss of weight and low-grade fever, a very high sedimentation rate and lymphocytes predominant in the peripheral circulation, pleural and peritoneal fluids. Pulmonary tuberculosis was seen in 18 patients (70%), 10 of whom presented with pleural effusions. There were extrapulmonary presentations in 8 of the 26 patients (30%). Most of the patients developed the disease about 1 year from the start of their dialysis treatment. With early therapy all patients survived their tuberculosis disease and no recurrence was seen in up to 5 years of follow-up. Despite earlier reports of high mortality, we suggest that awareness of the increased incidence of tuberculosis in dialysis patients, together with its unusual presentation and consequent early diagnosis, results in a very good prognosis.

Topics: Adult; Aged; Antibiotics, Antitubercular; Antitubercular Agents; Ethambutol; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Cavity; Prognosis; Radiography; Renal Dialysis; Rifampin; Tuberculosis, Pulmonary

Topics: Administration, Oral; Adolescent; Adult; Aged; Ampicillin; Clinical Trials as Topic; Cystitis; Female; Humans; Kidney Failure, Chronic; Male; Microbial Sensitivity Tests; Middle Aged; Prostatitis; Pyelonephritis; Rifampin; Urethritis; Urinary Tract Infections

Maintenance dialysis patients are at an increased risk for active tuberculosis (TB). In 2012, British Columbia, Canada, began systematically screening maintenance dialysis patients for latent TB infection (LTBI) and treating people with evidence of LTBI when appropriate. We examined LTBI treatment outcomes and compared treatment outcomes before and after rollout of the systematic screening program.. Retrospective cohort study.. The study comprised 365 people in British Columbia, Canada, initiating at least 90 days of dialysis from January 1, 2001, to May 31, 2017, and starting LTBI therapy: 290 (79.5%) people in the recent cohort and 75 (20.5%) in the historical cohort. People starting LTBI therapy from January 1, 2012, onward were classified as the recent cohort, whereas people starting LTBI therapy before January 1, 2012, were classified as the historical cohort.. Systematic LTBI screening and therapy.. Proportion of people who experience grade 3 to 5 adverse events (AEs) or any grade rash and end-of-treatment outcomes.. Outcomes were reported using descriptive statistics. 2-sample test of proportions using χ. 298 (81.6%) people successfully completed LTBI therapy. The proportion of people experiencing a grade 3 to 4 AE or any grade rash was 21.1%. Most AEs were related to gastrointestinal events, general malaise, or pruritus that resulted in regimen changes. 2 (0.5%) people were hospitalized for AEs related to LTBI therapy. No significant difference was found between the recent and historical cohorts in all outcomes of interest. No grade 5 AEs (deaths) were attributed to LTBI therapy.. Retrospective data and generalizability outside low-TB-burden settings.. Our findings suggest that a high proportion of people receiving maintenance dialysis can complete LTBI therapy. The rate of grade 3 to 4 AEs was high and associated with frequent medication changes during therapy. LTBI therapy in maintenance dialysis may be safe but requires close monitoring.

Topics: Aged; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Cohort Studies; Exanthema; Female; Gastrointestinal Diseases; Humans; Isoniazid; Kidney Failure, Chronic; Latent Tuberculosis; Male; Mass Screening; Middle Aged; Pruritus; Renal Dialysis; Retrospective Studies; Rifabutin; Rifampin; Treatment Outcome; Vitamin B 6

The detection and treatment of latent tuberculosis infection (LTBI) is a key step in eliminating tuberculosis (TB), but information on safety and on treatment interruption in elderly LTBI patients remains limited.. This multicenter prospective observational study included individuals with LTBI who underwent preventive therapy. Incidents of systemic adverse reactions (SARs) and treatment interruption rates in an elderly group (≥60 years old) and a young group (<60 years old) were analyzed.. A total of 406 LTBI patients, comprising 167 elderly and 239 young patients, were included in the analyses. The incidence of SARs was similar in the elderly group (18%) and the young group (15.1%). Being middle-aged (35-59 years), body mass index <23 kg/m. The occurrence of SARs was similar in the elderly (≥60 years old) and young (<60 years old) LTBI patients receiving preventive therapy. Extremely old (≥80 years old) LTBI patients had a higher treatment interruption rate, especially when they had SARs.

Topics: Adult; Aged; Aged, 80 and over; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Incidence; Isoniazid; Kidney Failure, Chronic; Latent Tuberculosis; Male; Middle Aged; Prospective Studies; Rifampin; Taiwan

Intestinal tuberculosis (TB) is rarely seen in patients with end-stage renal disease (ESRD). We report an intestinal TB case with a clinical presentation similar to that of colon cancer in a patient with ESRD on hemodialysis.. A 49-year-old man presented with a 3-month history of general weakness and anorexia. He had been treated for stage 5 chronic kidney disease (CKD) due to diabetic nephropathy for the last 3 years. His blood urea nitrogen and serum creatinine levels were 96.9 and 8.1 mg/dL, respectively, at the time of admission; azotemia was accompanied by severe anemia, hypoalbuminemia, hyperkalemia, and metabolic acidosis. Hemodialysis was initiated for suspected exacerbation of uremia; however, intermittent fever, night sweats, and abdominal discomfort persisted.. Abdominal computed tomography (CT) and whole-body F-fluorodeoxyglucose positron emission tomography were indicative of ascending colon cancer with lymph node metastases. However, colonoscopy with biopsy revealed the formation of submucosal caseating granuloma and acid-fast bacillus.. We initiated quadruple therapy with isoniazid, rifampicin, pyrazinamide, and ethambutol. The patient continued the quadruple regimen for the first 2 months before switching to dual therapy and received anti-TB medications for a total of 12 months.. After 9 months of standard anti-TB chemotherapy, polypoid residual lesions were noted during follow-up colonoscopy. Laparoscopy-assisted ileocecal resection was performed. No findings suggestive of recurrence of colonic TB were observed on follow-up abdominal CT at 6 months after discontinuation of anti-TB medications.. If non-specific uremic symptoms persist in patients with advanced CKD, the possibility of extrapulmonary TB such as intestinal TB must be considered. Also, in patients with radiologic suspicion of colon cancer, endoscopy with biopsy should be performed promptly to exclude colonic TB with similar clinical manifestations.

Topics: Anorexia; Antitubercular Agents; Drug Combinations; Ethambutol; Humans; Isoniazid; Kidney Failure, Chronic; Male; Middle Aged; Muscle Weakness; Pyrazinamide; Renal Dialysis; Republic of Korea; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal

The consequences of once-weekly rifapentine plus isoniazid for 3 months (3HP) against latent tuberculosis infections in hemodialysis patients have not been studied before. This is the first study to evaluate the safety and tolerability of 3HP in this population and revealed a completion rate of 65.4%. The therapy was not associated with hepatotoxicity, but with high rates of adverse events (69.2%).

Topics: Adult; Aged; Aged, 80 and over; Antitubercular Agents; Drug Administration Schedule; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Isoniazid; Kidney Failure, Chronic; Latent Tuberculosis; Male; Middle Aged; Renal Dialysis; Rifampin; Safety

Patients with end-stage renal disease (ESRD) are immunocompromised and are more at risk to develop and acquire Mycobacterium tuberculosis (MTB) infection. However, risk assessment is uncertain. The objective of current research was to study the frequency of MTB infection in ESRD patients . For this purpose, bronchoalveolar lavage (BAL) samples were evaluated for the presence of MTB by using GeneXpert®MTB/RIF test. We analysed 350 clinical samples of BAL collected from a tertiary care hospital in Pakistan, from September, 2015 to July, 2016. We performed the GeneXpert®test on each sample. According to our results prevalence of MTB was observed in 1.7% of bronchoalveolar lavage (BAL) samples taken from patients with chronic kidney diseases. All the positive samples were susceptible to rifampicin. There is a low prevalence of MTB infec tion (pulmonar y tuberculosis) in patients with chronic kidney disease in our setup. Suspected patients can be diagnosed by using GeneXpert®MTB/RIF testing on bronchoalveolar lavage samples.

Topics: Antibiotics, Antitubercular; Bronchoalveolar Lavage Fluid; Female; Humans; Immunocompromised Host; Kidney Failure, Chronic; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; Pakistan; Prevalence; Rifampin; Risk Assessment; Tertiary Care Centers; Tuberculosis

Patients undergoing renal replacement therapy have a higher risk of developing tuberculosis (TBC) in comparison with normal renal function population. The anergy to the tuberculin skin test, the lack of characteristic clinical symptoms of TBC and typical radiographic signs, and high prevalence of extrapulmonary TBC make the diagnosis in dialysis patients difficult and often delay the treatment. In contrast to the active TBC, latent TBC infection (LTBI) is asymptomatic and is not a direct epidemiological problem. However, in patients with end-stage renal disease prepared for renal transplantation, it is an obstacle to qualifying for immunosuppressive therapy. Treatment of LTBI patients with antimycobacterial medication decreases about 90% risk of developing active TB. Therefore, the possibility of a fast and easy identification of LTBI in this group of patients is extremely important. Test QuantiFERON-TB Gold In-Tube (QFT-G) is a new, simple and rapid diagnostic tool in LTBI and active tuberculosis infection (in conjunction with previously used clinical and microbiological methods). This test has been approved and is used in many European countries and in the USA. In a 65-year old patient, treated for 5 years with continuous ambulatory peritoneal dialysis, positive QFT-G results were shownin the course of diagnosis before reporting to the transplant program. After conducting an extensive diagnosis for tuberculosis infection (epidemiological interview, clinical examination, imaging studies, cultures by MB/BacT and the conventional method, consultations with a pulmonologist), latent form of tuberculosis was diagnosed with unspecified location. Due to the positive QFT-G and the need for future immunosuppressive treatment after kidney transplantation, a three-month prophylactic treatment with Rifamazyd 450 mg per day was included. After treatment, the patient entered the waiting list for a kidney transplant. Test QFT-G, in conjunction with other conventional methods is a good and rapid diagnostic tool in the identification of LTBI.

Topics: Aged; Antitubercular Agents; Drug Administration Schedule; Female; Humans; Isoniazid; Kidney Failure, Chronic; Kidney Transplantation; Latent Tuberculosis; Peritoneal Dialysis, Continuous Ambulatory; Rifampin; Tuberculin Test

Topics: Antibiotics, Antitubercular; Blood Pressure; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Rifampin; Tuberculosis

A 52-year-old woman was admitted to our hospital because of intermittent high fever and chronic renal failure. Computed tomography of the thorax showed swelling of the paratracheal lymph nodes that was confirmed by gallium scintigraphy. Biopsy of the supraclavicular lymph node on the right side showed necrotizing lymphadenitis with Langhans giant cells surrounded by epithelioid cells. Anti-tuberculosis treatment, including isoniazid, rifampicin, ethambutol, and pyrazinamide was initiated. One month after treatment, the patient developed agranulocytosis (white blood cell [WBC], 2100 cells/microl; neutrophils, 5%) accompanied by severe diarrhea. Bone marrow histology showed poor development of granulocytes, but no atypical cells were observed. Therefore, rifampicin was discontinued, and treatment with granulocyte colony-stimulating factor (G-CSF) was initiated. Subsequently, the white blood cell count and the proportion of neutrophils increased to 12500 cells/microL and 80%, respectively. Rifampicin in the anti-tuberculosis chemotherapy regimen was replaced with levofloxacin. This is a rare case of agranulocytosis caused by rifampicin administered during anti-tuberculosis treatment in a chronic renal failure patient.

Topics: Agranulocytosis; Antibiotics, Antitubercular; Female; Humans; Kidney Failure, Chronic; Middle Aged; Rifampin; Tuberculosis, Lymph Node

Extrapulmonary tuberculosis (TB) account for approximately 15-20% of TB cases in immunocompetent patients. The genitourinary system is the third most commonly affected site. We report the case of a 20-year-old man admitted with fever, chills, dry cough, right flank pain, and oliguria who developed renal function loss. The pyelogram evidenced silence of the right kidney, and the abdominal and pelvic magnetic resonance showed significant dilation of the right pyelocaliceal system and proximal ureter. Biopsies of renal cortex and retroperitoneal lymph nodes showed caseous granuloma consistent with TB. Treatment was started with rifampicin, isoniazid, pyrazinamide, and ethambutol, and the patient presented a favorable outcome but with non-dialytic chronic kidney disease. This case illustrates a case of chronic kidney disease secondary to TB in a young, otherwise healthy man.

Topics: Antitubercular Agents; Ethambutol; Fever; Humans; Isoniazid; Kidney Failure, Chronic; Male; Pyrazinamide; Renal Dialysis; Rifampin; Tuberculosis; Young Adult

Brucellosis is a zoonotic disease transmittable to humans. It is diagnosed either by isolation of Brucella organism in culture of blood or other sample types (e.g., bone marrow or liver biopsy specimens), or by a combination of serological tests and clinical findings. Dialysis patients constitute a special population group with an impaired autoimmune system and a propensity to develop infections, such as brucellosis. This paper presents the high incidence of brucellosis in our dialysis patients during last year, while there was not any zoonotic infection recorded in the previous at least 5 year period.. This is a retrospective study including 8 dialysis patients, undergoing renal replacement therapies (5 patients were on hemodialysis (HD) and 3 on peritoneal dialysis (PD)), who out of a total of 124 patients developed brucellosis, during the last year. Four patients were male and four female and their mean age was 67 +/- 9 years. Clinical presentation of Brucellosis infection was mild with low-grade fever and symptoms of influenza. All patients were living in places where animal brucellosis was prevalent. Infection was diagnosed on the basis of clinical symptoms and signs and with polymerase chain reaction (PCR) analysis of peripheral blood. The affected patients had consumed fresh unpasteurized milk and cheese and were treated with oral doxycycline and oral rifampicin for 6 weeks. All patients are in follow up for at least 1 year, during which there were no relapses.. Brucellosis is a zoonotic disease that can occur in dialysis patients who are susceptible to infection under certain conditions. Our brucellosis patients lived in agricultural and veterinary areas and had consumed unpasteurized milk and cheese and insufficiently cooked meat derived from infected animals.

Topics: Aged; Anti-Bacterial Agents; Brucella; Brucellosis; Doxycycline; Female; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Retrospective Studies; Rifampin; Treatment Outcome

Topics: Adult; Antitubercular Agents; Combined Modality Therapy; Drug Therapy, Combination; Ethambutol; Hemianopsia; Humans; Isoniazid; Kidney Failure, Chronic; Male; Optic Neuritis; Renal Dialysis; Rifampin; Tuberculosis

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Catheters, Indwelling; Diabetes Complications; Discitis; Endocarditis, Bacterial; Fever; Heart Valve Prosthesis; Humans; Hyperparathyroidism, Secondary; Incidence; Kidney Failure, Chronic; Lumbar Vertebrae; Methicillin Resistance; Prognosis; Renal Dialysis; Rifampin; Spain; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Case report describing spontaneous Corynebacterium diptheria discitis in a patient with chronic renal failure.. To describe this very rare form of discitis and the results of surgical and antibiotic therapy.. University Department of Neurosurgery, Turkey.. A 55-year-old man with chronic renal failure presented with acute low-back pain. Lumbar magnetic resonance imaging (MRI) suggested discitis and osteomyelitis at the L5-S1 level. The L5-S1 disc was operated upon and the discectomy material was sent for pathological and microbiological analysis.. Pathological examination revealed infection and bacterial culture grew C. diptheria. The patient was prescribed combination antibiotic therapy with vancomycin, a third-generation cephalosporin, and rifampicin. Clinical status improved after 8 weeks of therapy. Lumbar MRI revealed remission of the discitis and osteomyelitis after 10 months of follow-up.. Chronic renal failure patients with low-back pain should be investigated for spinal infection. These individuals are prone to low-grade infection in the form of discitis or osteomyelitis. Corynebacterium subspecies rarely cause spontaneous discitis. This case is interesting because of the unusual causal organism and the occurrence of discitis in the setting of chronic renal failure.

Topics: Anti-Bacterial Agents; Cephalosporins; Corynebacterium diphtheriae; Corynebacterium Infections; Diagnosis, Differential; Discitis; Diskectomy; Humans; Kidney Failure, Chronic; Low Back Pain; Lumbosacral Region; Magnetic Resonance Imaging; Male; Middle Aged; Rifampin; Vancomycin

Peritonitis is an uncommon complication of brucellosis. Brucella peritonitis in chronic ambulatory peritoneal dialysis (CAPD) patients has not been reported before. A male patient is presented with peritonitis caused by Brucella melitensis who was on CAPD. The source of infection was thought to be unpasteurized, unsalted cheese eaten a month before the onset of symptoms. At the beginning, antibiotic therapy with doxycyline and rifampicin led to a rapid clinical improvement, with disappearance of the organism in the peritoneal fluid. However, peritonitis relapsed after discontinuation of antimicrobial therapy. Successful management required a combination of medical therapy and removal of the Tenckhoff catheter.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Doxycycline; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rifampin

Topics: Aged; Antitubercular Agents; Drug Therapy, Combination; Female; Humans; Isoniazid; Kidney Failure, Chronic; Purpura, Thrombotic Thrombocytopenic; Rifampin; Streptomycin; Tuberculosis, Miliary

Hemodialysis permits a long term survival to patients with End Stage Renal Disease (E.S.R.D.). However the patients ongoing hemodialysis presented a immunodeficiency and a important modification of drugs biodisponibility. Tuberculosis is an endemic disease in our countries. Extrapulmonary tuberculosis is reported from these two cases among 13 patients treated in C.H.U.A. Le Dantec hemodialysis center. Clinical symptoms are not specific bacteria is not found. Diagnosis is obtained by a bundle of arguments. Antituberculosis treatment need to be adjusted in this field. Even if Rifampicine can be administrated at normal dose. The others drugs must be adapted on their clearance and the underlying disease. The two patients presented psychiatrical symptoms motivating a reduction of isoniazide dose witch threshold toxicity is lowered by renal failure state. These observations must increase watchfulness on nephrologist of undeveloping countries, confronted with tuberculosis renewed out break.

Topics: Adolescent; Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Hallucinations; Humans; Isoniazid; Kidney Failure, Chronic; Male; Metabolic Clearance Rate; Renal Dialysis; Rifampin; Senegal; Streptomycin; Tuberculosis

To identify factors associated with peritoneal dialysis-related infections at one center.. The study was a retrospective study of a 3-year time period with relatively stable treatment patterns.. A single center experienced academic peritoneal dialysis program.. Patients (N = 163) receiving peritoneal dialysis (PD) from January 1989 to December 1991 who had received treatment at home for at least one month.. None.. Catheter-related infection and peritonitis were the main outcome measures. Variables affecting infection rates that were assessed included age, time on PD, prior end-stage renal disease (ESRD) therapy, diabetic status, catheter type, exchange device, nasal carriage of S. aureus, and prophylactic rifampin therapy. Data were analyzed with univariate as well as with a fixed-effects and a mixed-effects gamma-Poisson multiple regression model.. Variables associated with an increased risk of new peritonitis included age under 20 years (p < 0.009; rate ratio 4.54) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.75). Decreased new peritonitis risk was associated with the ULTRA Set exchange system (p < 0.008; risk ratio 0.38) and intermittent prophylactic rifampin therapy (p < 0.001; rate ratio 0.99 for each 1% time on therapy). Catheter-related infections were increased in patients who had double-cuff catheters (p < 0.003) and nasal carriage of S. aureus (p < 0.04; rate ratio 1.82). Decreased catheter-related infections were noted in older patients (p < 0.02; rate ratio 0.983/year) and increasing months of study follow-up (p < 0.03; rate ratio 0.97/month).. In our program nasal carriage of S. aureus increased the risk of peritonitis and catheter-related infection. Prophylactic rifampin significantly decreased peritonitis, as did use of the ULTRA Set. Single-cuff opaque catheters had the lowest catheter infection rate. Analysis of the relationships between clinical and demographic variables and peritoneal dialysis-related infection rate can identify significant contributing or protective variables and allow peritoneal dialysis programs to develop preventive strategies to minimize the risk of infection.

Topics: Catheters, Indwelling; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Models, Statistical; Multivariate Analysis; Nasal Mucosa; Peritoneal Dialysis; Peritonitis; Retrospective Studies; Rifampin; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topics: Antitubercular Agents; Ethambutol; Humans; Isoniazid; Kidney Failure, Chronic; Pyrazinamide; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Topics: Ethambutol; Female; Humans; Immunosuppression Therapy; Isoniazid; Kidney Failure, Chronic; Kidney Transplantation; Middle Aged; Pancreatic Diseases; Postoperative Complications; Rifampin; Transplantation, Homologous; Tuberculosis

Topics: Adsorption; Amikacin; Ceftizoxime; Cimetidine; Famotidine; Humans; Kidney Failure, Chronic; Membranes, Artificial; Porosity; Protein Binding; Renal Dialysis; Rifampin

We measured pyrazinamide and rifampicin plasma concentrations in five patients with pulmonary tuberculosis and end stage renal failure treated by haemodialysis or continuous ambulatory peritoneal dialysis. Using conventional daily doses of oral pyrazinamide and rifampicin, we found that the drugs were removed efficiently by both dialysis methods, so that plasma levels were sub-optimal for maximal bactericidal action. These findings suggest that in patients with tuberculosis on maintenance dialysis, treatment should be either with higher doses of these two drugs, or with additional replacement doses given after each dialysis. Further detailed pharmacokinetic studies on larger numbers of patients are indicated.

Topics: Adolescent; Chromatography, High Pressure Liquid; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Pyrazinamide; Renal Dialysis; Rifampin; Tuberculosis, Pulmonary

Topics: Female; Hemolysis; Humans; Kidney Failure, Chronic; Middle Aged; Rifampin

Many factors are involved in choice of an antimicrobial agent. Cost has become a matter of increasing concern. Of course, overall expense for the hospitalized patient includes costs of tests for monitoring for toxicity as well as administration costs, which are affected by the dosing frequency. A reasoned choice necessitates knowledge of the place of newer agents in the therapeutic armamentarium and of some new applications of well-established drugs.

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cephalosporins; Clindamycin; Drug Interactions; Drug Therapy, Combination; Erythromycin; Humans; Kidney Failure, Chronic; Metronidazole; Penicillin Resistance; Penicillins; Rifampin; Tetracycline; Tissue Distribution; Vancomycin

Cyclosporin A trough blood levels were unusually low during rifampin treatment in a kidney transplant patient. Simultaneously, acute graft rejection occurred. Pharmacokinetic investigation revealed a rapid turnover of cyclosporin A leading to low blood levels. Cessation of rifampin therapy reversed these changes. Rifampin substantially reduces the bioavailability of cyclosporin A and should not be used in transplant recipients on cyclosporin A.

Topics: Adult; Biological Availability; Cyclosporins; Female; Graft Rejection; Humans; Kidney Failure, Chronic; Kidney Transplantation; Rifampin; Tuberculosis, Pulmonary

Digoxin doses required to maintain therapeutic serum concentrations rose substantially in two patients dependent on dialysis with the commencement of rifampin therapy. When rifampin was discontinued, doses fell to requirements before rifampin. Serum digoxin concentration may fall to ineffective levels with rifampin therapy and rise to potentially toxic levels when rifampin is discontinued.

Topics: Digoxin; Drug Administration Schedule; Drug Interactions; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Rifampin

Two renal allograft recipients who had received their organs from the same cadaver donor developed acute toxoplasmosis shortly after transplantation. Neither of the recipients had serologic evidence of previous exposure to Toxoplasma gondii at the time of surgery, but the donor had a positive indirect fluorescent antibody test. One of the recipients died during the fourth week, and multiorgan involvement with toxoplasmosis was demonstrated at autopsy. No evidence of the parasite could be found in the transplanted kidney. In the second recipient the disease was suspected, serologically demonstrated, and successfully treated. We concluded that toxoplasmosis was transmitted by the donor's kidneys, although this mode of transmission was not completely proven.

Topics: Adult; Cephalothin; Female; Gentamicins; Graft Rejection; Humans; Kidney Failure, Chronic; Kidney Transplantation; Methylprednisolone; Oxacillin; Rifampin; Toxoplasmosis

Rifampicin excretion with urine and its plasma levels were studied in 46 patients with nephrophthisis treated with rifampicin alone or in combination with isoniazid in doses of 8--10 mg/kg bw with regard to the degree of renal insufficiency. It was shown that excretion of rifampicin with urine decreased with progression of renal insufficiency and had no effect on its plasma levels. The combined use of isoniazid and rifampicin in a single dose was accompanied by a decrease in the latter's excretion with urine and different changes in its plasma concentration. The use of the two drugs for 4--6 weeks resulted in a further decrease in rifampicin excretion with urine not dependent on renal function and in decreased plasma levels of the antibiotic in 1/3 of patients. The findings indicate that the use of rifampicin in a dose less than 10 mg/kg of the body weight in patients with chronic renal insufficiency is not advisable. The absence of rifampicin in the urine specimens collected during the first hours on the 2nd day after its single use or its use for 4--6 weeks indicate that rifampicin does not accumulate in patients with renal insufficiency.

Topics: Administration, Oral; Drug Therapy, Combination; Humans; Isoniazid; Kidney Failure, Chronic; Kidney Function Tests; Kinetics; Rifampin; Time Factors; Tuberculosis, Renal

An immunocompromised patient with severe hypoxemia was found by transbronchial lung biopsy to have Torulopsis glabrata as the sole pathogen in lung. An antibody response to this organism was demonstrated, confirming its role as a pathogen and indicating a role for serodiagnosis of T glabrata infection.

Topics: Adult; Amphotericin B; Candida; Drug Therapy, Combination; Histoplasmosis; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Lung Diseases, Fungal; Male; Pneumonia; Rifampin

Topics: Ethambutol; Humans; Isoniazid; Kidney Failure, Chronic; Mycobacterium avium; Rifampin; Tuberculosis

Ten patients with proved disease caused by Myocobacterium tuberculosis were identified over a 10 year period in a population of 172 adult patients undergoing long-term dialysis. The incidence of tuberculosis was 12 times greater than that prevailing in the general community during the period of the study and could not be accounted for solely by demographic factors. Diagnosis was obscured because the symptoms were nonspecific and attributable to uremia, intermediate strength (5 TU) tuberculin tests were often negative, the roentgenographic appearance of pulmonary disease was often atypical, and there was more frequent extrapulmonary involvement. Impaired cellular immunity due to advanced renal failure may predispose to the increased incidence of tuberculosis and the greater frequency of extrapulmonary disease observed. Treatment was safe and effective in these patients using 300 mg of isoniazid and 8 to 10 mg/kg of ethambutol daily. Eight patients survived longer than one year following the diagnosis of tuberculosis, and all were clinically cured. No deaths were directly attributed to tuberculosis. A high index of suspicion and aggressive evaluation may be necessary to diminish the significant mortality described previously in association with disseminated disease.

Topics: Adult; Aged; Ethambutol; Female; Humans; Immunity, Cellular; Isoniazid; Kidney Failure, Chronic; Male; Middle Aged; Pyrazinamide; Renal Dialysis; Rifampin; Risk; Tuberculosis

Of more than 400 patients who received renal transplants in Cambridge, five subsequently developed tuberculosis. All had pulmonary involvement. Radiological abnormalities included miliary opacities, bilateral lower zone shadowing or typical upper zone shadowing with cavitation. Lung biopsy was required for diagnosis in two cases. Three patients recovered after treatment with antituberculosis drugs and none has relapsed. One died during chemotherapy despite drug-susceptible organisms. The problems encountered during chemotherapy are discussed.

Topics: Adult; Drug Administration Schedule; Female; Humans; Isoniazid; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Rifampin; Transplantation, Homologous; Tuberculosis, Pulmonary

Topics: Ambulatory Care; Ethambutol; Female; Humans; Isoniazid; Kidney Failure, Chronic; Pregnancy; Pregnancy Complications; Prothionamide; Rifampin; Streptomycin; Time Factors; Tuberculosis, Urogenital

Topics: Adult; Aged; Asthma; Cholecystitis; Drug Tolerance; Ethambutol; Female; Humans; Hypertension; Kidney Failure, Chronic; Male; Middle Aged; Peptic Ulcer; Rifampin; Tuberculosis, Pulmonary

Topics: Ambulatory Care; Antitubercular Agents; Drug Interactions; Ethambutol; Eye Diseases; Female; Follow-Up Studies; Hospitalization; Humans; Kidney Failure, Chronic; Pregnancy; Pregnancy Complications, Infectious; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Aminosalicylic Acids; Antitubercular Agents; Humans; Isoniazid; Kidney Failure, Chronic; Male; Renal Dialysis; Rifampin; Tuberculosis, Pulmonary

Topics: Half-Life; Humans; Kidney; Kidney Failure, Chronic; Renal Dialysis; Rifampin

Topics: Aminosalicylic Acids; Anti-Infective Agents; Creatinine; Gentamicins; Humans; Kidney Failure, Chronic; Liver Diseases; Rifampin

Topics: Agar; Bacteria; Biological Assay; Drug Resistance, Microbial; Humans; Injections, Intramuscular; Kidney; Kidney Failure, Chronic; Male; Microbial Sensitivity Tests; Rifampin; Time Factors

Topics: Administration, Oral; Chronic Disease; Humans; Intestinal Absorption; Kidney Diseases; Kidney Failure, Chronic; Peritoneal Dialysis; Renal Dialysis; Rifampin