rifampin and Pulmonary-Embolism

A 79-year-old man with a history of deep vein thrombosis and pulmonary embolism received anticoagulation therapy with warfarin 5 mg daily for 8 months. He was diagnosed with osteomyelitis and underwent partial metatarsal resection of his right foot. After surgery, antibiotics were initiated, including ertapenem sodium 1 g intravenously every 24 hours, vancomycin 1400 mg intravenously every 24 hours, and rifampin 300 mg by mouth twice daily. Achieving a therapeutic level of anticoagulation was difficult despite escalating doses of warfarin, because of the interaction with rifampin. A 5- to 6-fold increase in warfarin dose was prescribed to reach therapeutic international normalized ratios (INRs), but even these increases were insufficient to maintain his INR in the therapeutic range. After rifampin was discontinued, warfarin doses were gradually reduced over the next 2 months. When concurrent warfarin-rifampin therapy is necessary, vigilant monitoring is imperative and significant increases in warfarin doses are likely.

Topics: Aged; Antibiotics, Antitubercular; Anticoagulants; Drug Administration Schedule; Drug Interactions; Drug Monitoring; Humans; International Normalized Ratio; Male; Nursing Assessment; Osteomyelitis; Postoperative Care; Pulmonary Embolism; Rifampin; Risk Assessment; Venous Thrombosis; Warfarin

Topics: Adolescent; Anti-Bacterial Agents; Carbuncle; Community-Acquired Infections; Humans; Intracranial Embolism; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Pulmonary Embolism; Rifampin; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

A 33-year-old woman presented at 36 weeks gestation with worsening respiratory distress. A CT-pulmonary angiogram was performed to rule out a massive pulmonary embolism; instead, this identified extensive septic pulmonary emboli throughout both lung fields. Given the continuing maternal deterioration, a non-elective caesarean section was performed. A transoesophageal echocardiogram identified multiple large cardiac valve vegetations on both sides of her heart with an associated aortic root abscess. She responded well to a 6-week course of intravenous antibiotics.

Topics: Adult; Anti-Bacterial Agents; Coronary Angiography; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Floxacillin; Humans; Pregnancy; Pregnancy Complications, Infectious; Pulmonary Embolism; Respiratory Insufficiency; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

Daptomycin has demonstrated clinical efficacy in the treatment of methicillin-resistant Staphylococcus aureus-associated bacteremia and right-sided infective endocarditis. Although daptomycin is not approved for treatment of gram-positive pneumonia, clinical evidence suggests that it may be effective therapy for S. aureus-associated septic pulmonary emboli (SPE). We present our clinical experience with the use of daptomycin in combination with rifampin in four patients with SPE in the absence of infective endocarditis. Three of the patients had a history of injection drug use; two of these patients also had soft-tissue infections. All patients had clinical resolution of their infections. Daptomycin and rifampin appear to have a role in the treatment of methicillin-resistant S. aureus bacteremia with SPE in the absence of infective endocarditis and should be considered in patients that have failed therapy with vancomycin.

Topics: Adult; Aged; Anti-Bacterial Agents; Daptomycin; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pulmonary Embolism; Radiography; Rifampin; Sepsis; Staphylococcal Infections; Treatment Outcome

A 26-year-old pregnant woman who was an intravenous drug user (IDU) was admitted to our hospital for the treatment of tricuspid valve infective endocarditis (IE) and lung abscesses due to methicillin-resistant Staphylococcus aureus (MRSA). We started to treat her with vancomycin (VCM) alone and then in combination with rifampicin (RFP), but her condition did not improve. Then we added sulfamethoxazole/trimethoprim (SMZ/TMP) to VCM and RFP. After that, she improved rapidly. In Japan, there are very few reports about tricuspid valve IE caused by MRSA in IDUs. This case suggests that the combination of VCM, RFP, and SMZ/TMP may be effective for the treatment of severe MRSA infections.

Topics: Adult; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Lung Abscess; Methicillin-Resistant Staphylococcus aureus; Pregnancy; Pregnancy Complications, Infectious; Pulmonary Embolism; Rifampin; Staphylococcal Infections; Substance Abuse, Intravenous; Tricuspid Valve; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Aged; Arthritis, Infectious; Arthritis, Rheumatoid; Arthroplasty, Replacement, Knee; Autoimmune Diseases; Ciprofloxacin; Cloxacillin; Drug Therapy, Combination; Fatal Outcome; Humans; Immunocompromised Host; Knee Prosthesis; Male; Phlebitis; Postoperative Complications; Prosthesis-Related Infections; Pulmonary Embolism; Recurrence; Rifampin; Staphylococcal Infections; Staphylococcus; Virulence

Topics: Adrenal Cortex Hormones; Adrenergic beta-Antagonists; Asthma; Drug Therapy, Combination; Ethambutol; Female; Heparin; Humans; Infant, Newborn; Isoniazid; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Infectious; Pulmonary Embolism; Rifampin; Theophylline; Tuberculosis, Pulmonary

The drug interaction between warfarin and rifampin is not well known. Rifampin has been reported to increase the warfarin requirements in human subjects ingesting these agents simultaneously. The concomitant administration of rifampin and warfarin resulted in the need for an unusually high maintenance dose of warfarin (20 mg per day) in order to produce a therapeutic effect. Withdrawal of rifampin decreased the warfarin requirement by 50%. This effect may be mediated by the ability of rifampin to induce microsomal enzymes and, thus, the catabolism of warfarin. The effect of rifampin on the warfarin requirement of our patient appeared to be maximal 5 to 7 days after the initiation of rifampin and extended a similar length of time after rifampin withdrawal. This interaction appears to be clinically significant.

Topics: Drug Interactions; Humans; Male; Middle Aged; Prothrombin Time; Pulmonary Embolism; Rifampin; Warfarin