rifampin and Leukopenia

Daily, long-term treatment with minocycline 100 mg and rifampin 600 mg was initiated in 24 previously untreated borderline lepromatous (BL) and lepromatous (LL) patients for a total of 646 patient-months, averaging 26.9 months per patient. The same regimen was started in 12 BL and LL patients having a bacteriologic relapse for a total of 379 patient-months, averaging 32.5 months per patient, and in 12 patients judged to be at high risk for relapse for a total of 354 patient-months, averaging 29.5 months per patient. Daily, long-term treatment with clarithromycin 500 mg and rifampin 600 mg was initiated in 8 previously untreated BL and LL patients for a total of 174 patient-months, averaging 21.8 months per patient. The results in these 56 patients were compared to those obtained in 34 previously untreated BL and LL patients who were treated concurrently receiving daily, long-term dapsone 100 mg and rifampin 600 mg. No evidence of dangerous drug reactions or bone marrow, kidney or liver toxicity was seen in any of these five patient groups. Drug intolerance in 10 of the 90 patients studied necessitated discontinuing the chosen regimen, 4 from rifampin, 3 from dapsone, 2 from minocycline and 1 of undetermined attribution. The use of either minocycline or clarithromycin in conjunction with rifampin appears to pose no great risk when used long term.

Topics: Anti-Bacterial Agents; Clarithromycin; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Lepromatous; Leukopenia; Male; Minocycline; Recurrence; Rifampin

New antimycobacterial agents and combined treatment regimens are being introduced for the treatment of leprosy. Ofloxacin is one such broad spectrum antimicrobial agent. In this study rifampicin plus ofloxacin were administered daily for 4 weeks (daily supervised dose). Two patients (and possibly a third patient who refused all investigations) out of 125 patients developed leucocytopenia during the third week of therapy. It was associated with fever, malaise, nausea and loss of appetite. They recovered after cessation of drug treatment. Patients receiving ofloxacin should be monitored for constitutional symptoms suggestive of this complication even though the risk of such complication may be minimal.

Topics: Adolescent; Adult; Aged; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy, Borderline; Leprosy, Tuberculoid; Leukopenia; Male; Middle Aged; Ofloxacin; Rifampin

Little knowledge about the biological functions of RP11-37B2.1, a newly defined long noncoding RNA (lncRNA) molecule, is currently available. Previous studies have shown rs160441, located in the RP11-37B2.1 gene, is significantly associated with tuberculosis (TB) in a Ghanaian and the Gambian populations.. We investigated the influence of single-nucleotide polymorphisms (SNPs) within lncRNA RP11-37B2.1 on the risk of TB and the possible correlation with adverse drug reactions (ADRs) from TB treatment in a Western Chinese population. Four SNPs within lncRNA RP11-37B2.1 were genotyped in 554 TB cases and 561 healthy subjects using the improved multiplex ligation detection reaction method, and the patients were followed up monthly to monitor the development of ADRs.. No significant association between the SNPs of lncRNA RP11-37B2.1 and TB susceptibility was observed (all P > 0.05). Surprisingly, significant association was observed between two SNPs (rs218916 and rs160441) and thrombocytopenia development during anti-TB therapy under the dominant model (P = 0.003 and 0.014, respectively).. Our findings firstly exhibit that rs218916 and rs160441 within lncRNA RP11-37B2.1 significantly associate with the occurrence of thrombocytopenia and suggest RP11-37B2.1 genetic variants are potential biosignatures for thrombocytopenia during anti-TB treatment.

Topics: Adult; Anemia; Antitubercular Agents; Asian People; Case-Control Studies; China; Female; Genetic Predisposition to Disease; Humans; Isoniazid; Leukopenia; Male; Middle Aged; Polymorphism, Single Nucleotide; Prospective Studies; Rifampin; RNA, Long Noncoding; Thrombocytopenia; Tuberculosis

To examine the incidence rate by age and gender of leukopenia caused by chemotherapy including rifampicin (RFP) and isoniazid (INH), and to study the relationships between the leukopenia and the hepatic side effect or other haematological disorders such as thrombocytopenia.. Out of the tuberculosis patients who were admitted to our hospital in 1987-88, 1991-92, and 1996-2000, 1,525 patients (1,153 men, 372 women) were chosen for our study who had the white blood cell counts (WBC) in the peripheral blood more than 3,000/mm3 before chemotherapy, and underwent haematologic examination at least twice within 3 months after starting chemotherapy.. The definition of leukopenia was as follows: 1) WBC became less than 3,000/mm3 during chemotherapy for patients with pre-treatment WBC more than 4,000/mm3, or 2) WBC decreased more than 1,000/mm3 in patients with pre-treatment WBC between 3,000 and 4,000/mm3. The incidence rates of leukopenia by age, gender, and regimens of chemotherapy were calculated. The case-control study was done between the control and the leukopenia groups excluding patients suffered from agranulocytosis to clarify the hematological and biochemical characteristics of the leukopenia group. The control patients were chosen in the following way. For each patient with leukopenia, a patient with the same admission year, same gender, same regimen of chemotherapy, and the nearest age was chosen as a control patient. The changes in counts of white blood cell, granulocyte, and platelet, in hemoglobin concentration, and in hepatic enzyme levels before and during chemotherapy were compared between the leukopenia and the control groups. Thrombocytopenia was defined as platelet count less than 15 x 10(4)/mm3 and hepatic dysfunction as either asparate aminotransferase (AST) higher than 31 IU/l or alanine aminotransferase (ALT) higher than 34 IU/l.. (1) Incidence rate of leukopenia The leukopenia appeared in 36 patients (14 men, 22 women), two (one man, one woman) of whom showed agranulocytosis. The incidence rate was 1.2% (14/1,153) for men and 5.9% (22/372) for women. The incidence rate of women was higher than that of men in the age groups between 20 to 79 y.o., but no difference was seen in the age groups elder than 80 y.o. There were no differences in the incidence rate among groups treated with HRE (E: ethambutol), HRS (S: streptomycin), and HREZ (Z: pyrazinamide). The chemotherapy was continued in 30 patients after the appearance of leukopenia, and the natural recovery from leukopenia was seen in 19 patients, while the leukopenic state lasted during the chemotherapy in the remaining 11 patients. In two patients who exhibited agranulocytosis all drugs were discontinued. In the remaining 4 patients one or more drugs were discontinued. (2) Case-control study between leukopenia (N = 34) and the control (N = 34) groups There were no differences in age, sputum culture positivity on admission, degree of roentgenographic extent of the disease, ratio of cavity formation, and quantity of daily doses between the two groups. There was also no difference between the days until leukopenia appeared after starting chemotherapy (47.6 +/- 29.5 days) in the leukopenia group, and the days until WBC count became minimum within 3 months after starting chemotherapy (41.7 +/- 21.0 days) in the control group. The negativity of tuberculin skin testing was higher in the leukopenia group [7/14 (50%)] than in the control group [1/10 (10%)], however, the difference was statistically not significant due to rather small size of cases. Before the starting chemotherapy, the counts of WBC (7,230 +/- 1,530 vs 5,500 +/- 1,510/mm3, p < 0.001), neutrophil (5,230 +/- 1,450 vs 4,320 +/- 1,620/mm3, p < 0.05), lymphocyte (1,440 +/- 830 vs 830 +/- 440/mm3, p < 0.001) and platelet (34.9 +/- 12.2 vs 24.1 +/- 6.4 x 10(4)/mm3, p < 0.001) in the peripheral blood and the globulin level (3.71 +/- 0.61 vs 3.35 +/- 0.61 g/dl, p < 0.05) in the serum were significantly higher in the control group than in the leukopenia group. The decrements in the counts of WBC and granulocyte during chemotherapy were larger in the leukopenia group than in the control group (delta WBC: 2,880 +/- 1,530 vs 1,910 +/- 1,520/mm3, and delta Neut: 2,840 +/- 1,510 vs 1,820 +/- 1,380/mm3, p = 0.01, respectively), but the counts of lymphocyte were similar in both groups. Th. Leukopenia may occur in the course of treatment with anti-tuberculosis drugs, but it is not necessary to stop the chemotherapy immediately, because the WBC count recovers spontaneously or remains under stable leukopenic state during chemotherapy in most cases. But when leukopenia appears, the peripheral blood counts must be checked cautiously, and the chemotherapy should be stopped if the WBC count progressively decreases. The patients who showed leukopenia due to anti-tuberculosis drugs may have had weaker natural and acquired (cell-mediated) immunologic response to tuberculosis infection, and more vulnerable bone marrow cells and hepatic cells to anti-tuberculosis drugs than the control.

Topics: Adult; Aged; Antitubercular Agents; Female; Humans; Isoniazid; Leukopenia; Male; Middle Aged; Rifampin

This study surveys the extent and severity of haematological abnormalities which occurred in 380 patients with pulmonary tuberculosis. Full blood count, bone marrow aspiration smears, and bone marrow trephine biopsy was analyzed by authors. Anaemia was present in 32 percent of patients. Leucocytosis with neutrophilia occurred in 18 percent. Leucopenia with neutropenia, and lymphopenia was observed in 16 percent in patients with very severe clinical tuberculosis. Elevated platelet count occurred in 8 percent with deep vein thrombosis in legs in 50 percent. Dysmyelopoietic syndrome was diagnosed in one case by bone marrow trephine biopsy. There was a close correlation between the haematological abnormalities and the severity of clinical findings of pulmonary tuberculosis. This survey has revealed that haematological abnormalities are relatively common in severe pulmonary tuberculosis. It seems that body weight loss, white blood cell count, haemoglobin level and erythrocyte sedimentation rate are useful indices of severity of the tuberculosis. The return of these indices to a normal level is a good indication of disease control in that they correlate with sputum conversion to acid-fast bacilli negative.

Topics: Anemia; Antitubercular Agents; Ethambutol; Hematologic Diseases; Humans; Leukopenia; Pancytopenia; Pyrazinamide; Rifampin; Tuberculosis, Pulmonary

Treatment of disseminated Pseudomonas aeruginosa infection in leukopenic mice was evaluated using cefpirome alone and in combination with gentamicin and/or rifampin. Mice were made leukopenic with cyclophosphamide and infected through a skin incision with an inoculum of 1250 organisms (13 LD50). Antibiotics were administered subcutaneously for 48 h. Although the addition of cefpirome to gentamicin and/or rifampin improved survival significantly at 48 h compared with untreated controls (84.6%-100% vs. 38.5%), therapy with these combinations did not improve survival significantly from that achieved with cefpirome alone. Quantitative blood and tissue (liver, spleen, kidney, lung) cultures in mice treated with cefpirome alone or including rifampin were lower than in infected controls or groups receiving therapy that excluded cefpirome. Highest counts were observed in mice receiving cefpirome plus gentamicin. Except for the cefpirome plus gentamicin group, which demonstrated areas of acute tubular necrosis, the cefpirome group had less tissue pathology than infected controls.

Topics: Animals; Cefpirome; Cephalosporins; Drug Therapy, Combination; Gentamicins; Kidney; Leukopenia; Liver; Lung; Male; Mice; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Rifampin; Spleen

Topics: Humans; Leukopenia; Random Allocation; Rifampin; Time Factors; Tuberculosis

Leucopenia (= leucocyte count 3000 cells/microliters or less) caused by 2 rifampicin preparations used in daily tuberculosis chemotherapy was studied. In a group of 140 patients treated with Rimapen (Orion, Finland ), 11 cases (7.9%) of leucopenia were detected. In a group of 132 patients treated with Rimactan (Ciba-Geigy, Switzerland) one case of leucopenia (0.8%) occurred. The difference is statistically significant (p less than 0.01). The frequency of leucopenia in the Rimapen group was much higher than that reported in the literature. In cases of leucopenia caused by rifampicin the recommended measure is withdrawal of the drug or continued treatment under careful observation. If possible, rifampicin treatment should not be resumed after a pause, irrespective of its length.

Topics: Bone Marrow; Drug Therapy, Combination; Humans; Leukocyte Count; Leukopenia; Platelet Count; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

A case of fatal meningitis and septicemia with group JK Corynebacterium species in a leukopenic patient is reported. The strain was susceptible to rifampicin and vancomycin only. The finding of diphtheroids in bacteriological samples from immunocompromised patients should not be ignored. The literature regarding meningitis caused by diphtheroid bacilli is reviewed.

Topics: Adult; Burkitt Lymphoma; Corynebacterium; Humans; Leukopenia; Male; Meningitis; Rifampin; Vancomycin

Topics: Bone Marrow; Bone Marrow Examination; Cholestasis; Erythema; Ethambutol; Humans; Isoniazid; Leukopenia; Male; Middle Aged; Neutropenia; Peritonitis, Tuberculous; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis; Tuberculosis, Hepatic; Tuberculosis, Osteoarticular; Tuberculosis, Splenic; Vitamin B Complex

Topics: Adult; Agranulocytosis; Alkaline Phosphatase; Antitubercular Agents; Aspartate Aminotransferases; Bilirubin; Drug Resistance, Microbial; Eosinophilia; Female; Humans; Isoniazid; Leukopenia; Male; Middle Aged; Rifampin; Sputum; Streptomycin; Tuberculosis, Pulmonary; Uric Acid

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