rifampin and Peripheral-Vascular-Diseases

The aim of this systematic review and meta-analysis was to determine the effectiveness of perioperative strategies to prevent infection in patients undergoing peripheral arterial reconstruction.. All randomized controlled trials (RCTs) evaluating measures intended to reduce or prevent infection in arterial surgery were identified through searches of the Cochrane Peripheral Vascular Diseases Group specialized trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), and reference lists of relevant articles. Two authors independently selected and assessed the quality of included trials. Relative risk (RR) was used as a measure of effect for each dichotomous outcome.. The study included 34 RCTs. Of these, 22 were trials of prophylactic systemic antibiotics, 3 of rifampicin-bonded grafts, 3 of preoperative skin antisepsis, 2 of suction wound drainage, 2 of minimally invasive in situ bypass techniques, and individual trials of intraoperative glove change and wound closure techniques. Wound infection or early graft infection outcomes were recorded in all trials. Only two trials, both of rifampicin bonding, followed up graft infection outcomes to 2 years. Prophylactic systemic antibiotics reduced the risk of wound infection (RR, 0.25; 95% confidence interval [CI], 0.17 to 0.38) and early graft infection in a fixed-effect model (RR, 0.31; 95% CI, 0.11 to 0.85, P = .02). Antibiotic prophylaxis for >24 hours appeared to be of no added benefit (RR, 1.28; 95% CI, 0.82 to 1.98). There was no evidence that prophylactic rifampicin bonding to Dacron grafts reduced graft infection at 1 month (RR, 0.63; 95% CI, 0.27 to 1.49), or 2 years (RR, 1.05; 95% CI, 0.46 to 2.40). There was no evidence of a beneficial or detrimental effect on rates of wound infection with suction groin wound drainage (RR, 0.96; 95% CI, 0.50 to 1.86) or from preoperative bathing with antiseptic agents compared with unmedicated bathing (RR, 0.97; 95% CI, 0.70 to 1.36).. There is clear evidence of the benefit of prophylactic broad-spectrum antibiotics for vascular reconstruction. Many other interventions intended to reduce the risk of infection in arterial reconstruction lack evidence of effectiveness.

Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Antisepsis; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Drug Administration Schedule; Humans; Peripheral Vascular Diseases; Prosthesis Design; Prosthesis-Related Infections; Rifampin; Risk Assessment; Risk Factors; Suction; Surgical Wound Infection; Treatment Outcome

Rifalazil is a benzoxazinorifamycin which inhibits bacterial DNA-dependent RNA polymerase. The benzoxazine ring endows benzoxazinorifamycins with unique physical and chemical characteristics which favor the use of rifalazil and derivatives in treating diseases caused by the obligate intracellular pathogens of the genus chlamydia. Minimal inhibitory concentrations of benzoxazinorifamycins against chlamydia are in the pg/mL range. These compounds have potential as monotherapeutic agents to treat chlamydia-associated disease because they retain activity against chlamydia strains resistant to currently approved rifamycins such as rifampin. A pivotal clinical trial with rifalazil has been initiated for the treatment of peripheral arterial disease. The rationale for this innovative use of rifalazil, including the association of C. pneumoniae in atherosclerotic plaque formation, as well as rifalazil's potency and efficacy against chlamydia in both preclinical and clinical studies, is discussed. Other benzoxazino derivatives may have utility as stand-alone topical antibacterials or combination antibacterials to treat serious Gram-positive infections. None of the benzoxazinorifamycins examined to date induce the cytochrome P450 3A4 enzyme. This is in contrast to currently approved rifamycins which are strong inducers of P450 enzymes, resulting in drug-drug interactions that limit the clinical utility of this drug class.

Topics: Animals; Anti-Bacterial Agents; Atherosclerosis; Chlamydia Infections; Chlamydophila pneumoniae; Humans; Peripheral Vascular Diseases; Rifampin; Rifamycins

The aim of this study was to determine whether the routine use of an antibiotic-bonded gelatin-coated Dacron graft could reduce the incidence of prosthetic graft infection. Extra-anatomic grafts were chosen for study as they have the highest risk of graft infection. This paper reports early results up to 1 month after surgery.. This multicentre study involved 14 vascular units in the UK. A total of 257 patients underwent extra-anatomic bypass. Patients were randomized to rifampicin bonding (1 mg/ml rifampicin soak for 15 min before graft insertion) or a control group. Routine three-dose antibiotic prophylaxis was administered to patients in both groups.. There were 178 men and 79 women of median age 69 (range 43-92) years. Rifampicin-bonded (n=123) and control (n=134) groups were well matched for clinical details, risk factors and operative techniques. No side-effects were noted from rifampicin bonding. Only one patient (in the control group) developed a graft infection and this proved fatal. There were no significant differences between bonded and unbonded grafts in terms of perioperative mortality rate (9 and 5 per cent respectively), median hospital stay (10 days for both groups), total infective complications (15 and 21 per cent respectively) or need for postoperative antibiotics (13 and 18 per cent respectively).. Early results from this study have not identified any significant advantage in the routine use of rifampicin bonding, but the rate of graft infection was very low (0.4 per cent). Gelatin coating alone may provide protection against infection. Definitive recommendations about the role of antibiotic bonding cannot be made until longer follow-up becomes available.

Topics: Aged; Aged, 80 and over; Antibiotics, Antitubercular; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Female; Humans; Length of Stay; Male; Middle Aged; Peripheral Vascular Diseases; Polyethylene Terephthalates; Prosthesis-Related Infections; Rifampin

Topics: Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Blood Vessel Prosthesis; Drug Therapy, Combination; Female; Gelatin; Humans; Male; Peripheral Vascular Diseases; Polyethylene Terephthalates; Prospective Studies; Prosthesis Design; Prosthesis-Related Infections; Rifampin