rifampin and Purpura

Persistent conjunctival carriage of the Haemophilus influenzae biogroup aegyptius (Hae) strain (BPF clone) responsible for Brazilian purpuric fever (BPF) has been documented. Topical chloramphenicol is routinely used to treat conjunctivitis in areas affected by BPF in Brazil. Although the BPF clone is susceptible to chloramphenicol, we observed a number of children treated with topical chloramphenicol for conjunctivitis who still developed BPF. During an investigation of an outbreak of BPF in Mato Grosso State, Brazil, we compared oral rifampin (20 mg/kg/day for 4 days) with topical chloramphenicol for eradication of conjunctival carriage of H. influenzae biogroup aegyptius among children with presumed BPF clone conjunctivitis. Conjunctival samples were taken for culture on the day treatment was initiated and a mean of 8 and 21 days later. At 8 days the eradication rates for oral rifampin and topical chloramphenicol were 100 and 44%, respectively (P = 0.003); at 21 days they were 100 and 50% (P = 0.01). Oral rifampin was more effective than topical chloramphenicol for eradication of the BPF clone and may be useful in prevention of BPF.

Topics: Administration, Oral; Administration, Topical; Brazil; Carrier State; Child; Child, Preschool; Chloramphenicol; Conjunctivitis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Oropharynx; Purpura; Rifampin; Species Specificity

The present report concerns the results at 1 year of a co-operative controlled clinical study carried out in Poland of the retreatment of patients with active, chronic, polyresistant far-advance pulmonary tuberculosis with an oral regimen of daily followed by intermittent ethambutol and rifampicin. A comparison was made of once- and twice-weekly supervised intermittent regimens of rifampicin 1200 mg plus ethambutol 50 mg/kg body weight under out-patient conditions after an initial inpatient phase of rifampicin 600 mg and ethambutol 25 mg/kg daily for 12 weeks. Patients were allocated at random to the regimens. Of 247 patients admitted to the study, 201 (81 per cent) completed 1 year's treatment as prescribed by the protocol, 46 (19 per cent) patients terminated their treatment prematurely before 1 year. After the daily phase of 12 weeks' treatment, 82 per cent were negative on smear and 85 per cent on culture; in the continuation intermittent phase, 98 per cent of patients in the once-weekly (E1R1) regimen were negative on culture at 28 weeks and 98 per cent in the twice-weekly (E2R2) regimen. The corresponding proportions at 52 weeks were 97 per cent and 97 per cent. At 12 months, 96 per cent of 101 ER/E1R1 and 96 per cent of 100 ER/E2R2 patients who completed 1 years' treatment were culture-negative.

Topics: Adolescent; Adult; Aged; Chronic Disease; Clinical Trials as Topic; Drug Administration Schedule; Drug Hypersensitivity; Drug Resistance, Microbial; Ethambutol; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Purpura; Rifampin; Sputum; Tuberculosis, Pulmonary; Vision Disorders

This paper reports the nature, incidence, and severity of adverse reactions to regimens of rifampicin and ethambutol given once weekly, twice weekly, or daily and to a standard reserve regimen in a total of 330 Chinese failure patients who completed at least six months' chemotherapy in a therapeutic comparison in Hong Kong.The adverse reactions which occurred on the regimens of intermittent rifampicin were termed cutaneous, abdominal, "flu", and respiratory; in addition, purpura and abnormal liver function tests were encountered. There was an association of adverse reactions with the interval between doses and with the dose size of rifampicin, the highest incidence occurring with once-weekly rifampicin in high dosage. A procedure was developed for managing adverse reactions to intermittent rifampicin. Of 202 patients treated with intermittent rifampicin 60 developed adverse reactions, but in only 7 (3%) was it necessary to terminate the drug, though a further 10 (5%) were changed to daily rifampicin. On daily rifampicin, generalized hypersensitivity, cutaneous reactions, (one with purpura), and impaired liver function were encountered. Adverse reactions on the standard ethionamide, pyrazinamide, and cycloserine regimen were frequent and some were serious.

Topics: Alanine Transaminase; Antitubercular Agents; Bone Diseases; Chemical and Drug Induced Liver Injury; Colic; Drug Eruptions; Dyspnea; Ethambutol; Fever; Hong Kong; Humans; Jaundice; Purpura; Rifampin; Time Factors; Tuberculosis, Pulmonary

Disseminated intravascular coagulation (DIC) induced by daily rifampicin therapy is rare, especially the patient is absent of malignancy, severe infection, and prior exposure to rifampicin.. We report a case of DIC induced by daily rifampicin treatment for pulmonary tuberculosis. A 22-year-old, previously healthy man received an anti-tuberculosis therapy consisting of isoniazid, rifampicin, ethambutol, and pyrazinamide on the daily dose recommended by the World Health Organization tuberculosis guidelines after a diagnosis of pulmonary tuberculosis. Two weeks later, he was transferred to the West China Hospital with nasal hemorrhage for 1 week, hematochezia, hematuria, and petechiae for 5 days.. Laboratory data and symptoms on admission indicated DIC.. The anti-tuberculosis drugs were discontinued after admission and he was initiated with targeted treatment for DIC, omeprazole and polyene hosphatidylcholine infusion, as well as nutrition supportive treatment. Five days after admission, ethambutol, moxifloxacin, and amikacin were added to the patient without further active hemorrhage. Eight days after admission, the platelet count had risen gradually. Isoniazid was administered on 24 days after admission, while his liver function tests and platelet counts returned to normal. No recurrence of DIC occurred. The diagnosis of rifampicin-induced DIC was confirmed.. The patient recovered and left hospital with isoniazid, ethambutol, levofloxacin, and streptomycin after 4 weeks of hospitalization. There was no recurrence of DIC or hemorrhage during the 8 months of follow-up. The literature review revealed that there were 10 other cases of rifampicin-induced DIC. Only 4 cases received rifampicin on a daily basis for pulmonary tuberculosis treatment and the others were on intermittent dosing schedule for pulmonary tuberculosis or leprosy treatment.. As a rare adverse effect, DIC induced by rifampicin occurs irregularly and unpredictably, which is reported to be more associated with the intermittent usage of rifampicin, but can occur with rifampicin daily administration. Identification of early symptoms, drug discontinuation, supportive management, and regular monitoring are the key points to correct this adverse effect, which may contribute to severe even fetal results in patients and deserves more attention.

Topics: Antitubercular Agents; China; Disseminated Intravascular Coagulation; Gastrointestinal Hemorrhage; Hematuria; Humans; Male; Purpura; Rifampin; Tuberculosis, Pulmonary; Young Adult

Thrombocytopenia is an uncommon but potentially life threatening complication of certain anti-tubercular drugs and is characterized by rapid destruction of platelets whenever an offending drug is taken by a susceptible person. Here is a case report of Rifampicin induced Thrombocytopenia. This case is being reported for purpose of its rare occurrence and documentation.

Topics: Adult; Antibiotics, Antitubercular; Female; Humans; Purpura; Rifampin; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Aged; Antitubercular Agents; Female; Humans; Middle Aged; Purpura; Rifampin; Skin; Tuberculosis, Pulmonary; Vasculitis

Topics: Adult; Antibiotics, Antitubercular; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Drug Administration Schedule; Drug Hypersensitivity; Ethambutol; Humans; Isoniazid; Male; Middle Aged; Purpura; Pyrazinamide; Rifampin; Streptomycin; Thrombocytopenia; Tuberculosis, Pulmonary

Topics: Cryoglobulins; Erythema; Humans; Hypersensitivity; Purpura; Rifampin; Skin; Skin Diseases; Syndrome; Vascular Diseases

Topics: Adult; Aged; Aminosalicylic Acids; Drug Combinations; Drug Hypersensitivity; Female; Humans; Isoniazid; Male; Middle Aged; Purpura; Rifampin; Streptomycin; Tuberculosis, Pulmonary