rifampin and Respiratory-Insufficiency

Topics: Acute Disease; Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Aerosols; Asthma; Bronchitis; Chromones; Chronic Disease; Ethambutol; Humans; Mycoplasma Infections; Respiratory Insufficiency; Respiratory Tract Diseases; Respiratory Tract Infections; Rifampin; Tuberculosis; Tuberculosis, Pulmonary; Virus Diseases

Topics: Clinical Trials as Topic; Drug Hypersensitivity; Drug Therapy, Combination; Ethambutol; Fever; Gastrointestinal Diseases; Humans; Jaundice; Purpura, Thrombocytopenic; Respiratory Insufficiency; Rifampin; Skin Manifestations; Time Factors; Tuberculosis, Pulmonary

Infective endocarditis is associated with a variety of clinical signs, but its association with multisystem vasculitis is rarely reported. A high index of suspicion is necessary to differentiate a primary autoimmune vasculitis from an infectious cause as the wrong treatment can lead to significant morbidity and mortality. We present a 71-year-old female patient with negative blood cultures, on antibiotics for recent bacteraemia, who presented with cutaneous and renal leucocytoclastic vasculitis. Workup revealed a vegetation adjacent to her right atrial pacemaker lead consistent with infective endocarditis and her vasculitis completely resolved with appropriate antibiotics.

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Bacteremia; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Pulmonary Edema; Renal Dialysis; Respiratory Insufficiency; Rifampin; Skin Diseases, Vascular; Staphylococcal Infections; Vasculitis

Unilateral hypoplasia of the lung is a rare congenital condition, the mechanism of which is poorly understood. Primary pulmonary hypoplasia occurring in an adult is extremely rare and we present what is probably the first case of a link to a tuberculous pleural effusion in a young woman after childbirth.. Herein, we describe a 31-year-old woman with left lung hypoplasia, and she not only survived to adulthood without problems, but was able to deliver a baby in natural labor.. Left lung hypoplasia, right tuberculous pleural effusion.. We initiated an anti-tuberculosis treatment for this patient with dose adjustments to her weight of isoniazid (0.3 g/day), rifampicin (0.45 g/day), pyrazinamide (1.5 g/day), and ethambutol (0.75 g/day) for 2 months then isoniazid and rifampicin for another 4 months.. Ten days later after beginning therapy, she became afebrile and the pleural effusion resolved. No recurrence was observed during a 6-month follow-up period.. In clinical practice, if one sees a chest x-ray revealing complete or incomplete opacification of a hemithorax with volume loss and history of repeated respiratory infections, one should consider the possibility of unilateral pulmonary hypoplasia. In such cases, regular close follow-up is important to minimize infections and to prevent development of cor pulmonale or respiratory failure.

Topics: Abnormalities, Multiple; Adult; Antitubercular Agents; Ethambutol; Female; Humans; Isoniazid; Lung; Lung Diseases; Mycobacterium tuberculosis; Parturition; Pleural Effusion; Pregnancy; Pulmonary Heart Disease; Respiratory Insufficiency; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pleural; Tuberculosis, Pulmonary

Nontuberculous mycobacteria (NTM) caused pulmonary disease is on increase worldwide, especially in countries with decreasing time trend of tuberculosis incidence. NTM skeletal affection is rare. Mycobacterium avium related disease, with still unclear clinical and radiologic features, is in current focus of both clinicians and researchers. An exhausted severely ill 71-year-old man was admitted on emergency due to cough, dyspnea and lumbar back pain to be diagnosed with terminal phase M. avium disease. Three sputum smears were positive for acid fast bacilli and M. avium was identified with hybridization reaction by means of GenoType ® MTBC (Hain). Apart from pulmonary disease, compressive fractures of the 12th thoracic and 1-4th lumbar vertebrae were detected. We found age, chronic alcoholism, previous professional exposure, tobacco smoking, chronic obstructive pulmonary disease and previous tuberculosis as risk factors for NTM disease in the HIV-negative patient. Despite combined antibiotic treatment, disease had lethal outcome. This case report might contribute to clinicians' awareness and improved knowledge on this sort of pathology, and lead to earlier diagnosis with possibly better disease outcome.

Topics: Aged; Clarithromycin; Drug Therapy, Combination; Ethambutol; Fatal Outcome; Humans; Lung Diseases; Male; Mycobacterium avium; Mycobacterium Infections, Nontuberculous; Respiratory Insufficiency; Rifampin; Risk Factors; Spinal Diseases; Sputum

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

The tuberculostatic compound rifampin (INN, rifampicin) induces the expression of a number of drug metabolism-related genes involved in multidrug resistance (P-glycoprotein and multidrug resistance proteins 1 and 2), cytochromes (cytochrome P450 [CYP] 3A4), uridine diphosphate-glucuronosyltransferases, monoamine oxidases, and glutathione S -transferases. Drugs that depend on these enzymes for their metabolism are prone to drug interactions when coadministered with rifampin. A novel, clinically relevant drug interaction is described between rifampin and mycophenolate mofetil (MMF), a cornerstone immunosuppressive molecule used in solid organ transplantation. Long-term rifampin therapy caused a more than twofold reduction in dose-corrected mycophenolic acid (MPA) exposure (dose-interval area under the concentration curve from 0 to 12 hours [AUC 0-12]) when administered simultaneously in a heart-lung transplant recipient, whereas subsequent withdrawal of rifampin resulted in reversal of these changes after 2 weeks of washout (dose-corrected AUC 0-12 after rifampin withdrawal, 19.7 mg.h.L-1.g -1 versus 6.13 mg.h.L-1.g-1 before rifampin withdrawal [221% change]; dose-uncorrected AUC 0-12 after rifampin withdrawal, 29.6 mg.h/L [daily MMF dose, 3 g] versus 18.4 mg.h/L [daily MMF dose, 6 g] during rifampin administration [60.8% change]). Failure to recognize this drug interaction could potentially lead to MPA underexposure and loss of clinical efficacy. The effect of rifampin on MPA metabolism can, at least in part, be explained by simultaneous induction of renal, hepatic, and gastrointestinal uridine diphosphate-glucuronosyltransferases and organic anion transporters with subsequent functional inhibition of enterohepatic recirculation of MPA.

Topics: Area Under Curve; Chronic Disease; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Interactions; Drug Therapy, Combination; Enterohepatic Circulation; Glucuronosyltransferase; Heart-Lung Transplantation; Histiocytosis, Langerhans-Cell; Humans; Hypertension, Pulmonary; Male; Metabolic Clearance Rate; Middle Aged; Mycophenolic Acid; Pharmacology, Clinical; Respiratory Insufficiency; Rifampin; Tacrolimus; Time Factors; Uridine Diphosphate; Withholding Treatment

The patient was a 74 year-old male presenting right pleural effusion with mild fever. His temperature was 37.0 degrees C. Culture of a pleural biopsy specimen revealed Mycobacterium tuberculosis, although culture of sputum and pleural effusion were negative. Therapy was begun with 300 mg of isoniazid (INH) per day, 600 mg of rifampicin (RFP) per day, and 1200 mg of pyrazinamide (PZA) per day. His temperature improved temporarily. One week after beginning of the therapy he had a fever over 38.0 degrees C. On the 17th day after starting chemotherapy, a chest radiological examination showed left pleural effusion in which numerous lymphocytes were found but Mycobacterium tuberculosis was negative. We assumed that the left pleural effusion was due to a paradoxical reaction to the anti-tuberculosis chemotherapy. After 3 days' discontinuation, the same regimen was resumed with an addition of prednisolone, but bilateral pleural effusion remained and the case finally fell into chronic respiratory failure.

Topics: Aged; Antitubercular Agents; Chronic Disease; Drug Therapy, Combination; Humans; Isoniazid; Male; Pleural Effusion; Pyrazinamide; Respiratory Insufficiency; Rifampin; Tuberculosis, Pleural

To determine whether foals with pneumonia that were treated with erythromycin, alone or in combination with rifampin or gentamicin, had a higher risk of developing adverse effects, compared with foals treated with trimethoprim-sulfamethoxazole (TMS), penicillin G procaine (PGP), or a combination of TMS and PGP (control foals).. Retrospective study.. 143 foals < 240 days old.. Information on age, sex, breed, primary drug treatment, total days of treatment with the primary drug, and whether the foal developed diarrhea, hyperthermia, or respiratory distress was obtained from the medical records. Relative risk (RR) and attributable risk (AR) were calculated to compare risk of adverse reactions between foals treated with erythromycin and control foals.. Only 3 (4.3%) control foals developed diarrhea; none developed hyperthermia or respiratory distress. Foals treated with erythromycin had an 8-fold risk (RR, 8.3) of developing diarrhea, compared with control foals, and increased risks of hyperthermia (AR, 25%) and respiratory distress (AR, 15%).. Results suggest that use of erythromycin to treat foals with pneumonia was associated with an increased risk of diarrhea, hyperthermia, and respiratory distress, compared with use of TMS or PGP.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Diarrhea; Drug Therapy, Combination; Erythromycin; Female; Fever; Gentamicins; Horse Diseases; Horses; Male; Penicillin G Procaine; Penicillins; Pneumonia; Respiratory Insufficiency; Retrospective Studies; Rifampin; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumonia caused by Legionnaires' disease bacterium was recognized in eight patients during a 7-month period. The patients were immunosuppressed by their underlying illness, corticosteroid therapy, and other exogenous immunosuppressive agents. Five of the patients had received immunosuppressive therapy for less than 16 days. Clinical presentation was similar to that of other bacterial pneumonias in compromised patients. Legionnaires' disease progressed to necrotizing pneumonia with abscess formation and respiratory failure in two patients. Diagnosis was made by [1] culture of lung tissue and bronchial washings; [2] direct fluorescent antibody staining of lung tissue, sputum, and bronchial washings; and [3] serologic evidence of infection. Therapy with oral erythromycin was ineffective. Intravenous erythromycin was given to six patients, with a good response. However, two patients showed further clinical improvement after rifampin was added. Because this illness may be more severe in compromised hosts, open lung biopsy and special microbiologic tests should be done when Legionnaires' disease is suspected.

Topics: Adrenal Cortex Hormones; Adult; Aged; Erythromycin; Female; Hematologic Diseases; Humans; Immunosuppression Therapy; Kidney Transplantation; Legionnaires' Disease; Male; Middle Aged; Respiratory Insufficiency; Rifampin; Transplantation, Homologous

Topics: Acute Kidney Injury; Antibodies; Dose-Response Relationship, Drug; Drug Hypersensitivity; Hemorrhagic Disorders; Humans; Respiratory Insufficiency; Rifampin; Tuberculosis, Pulmonary

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