rifampin and Substance-Related-Disorders

Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of <100 per 100 000 per year. The guidelines strongly recommend systematic testing and treatment of LTBI in people living with HIV, adult and child contacts of pulmonary TB cases, patients initiating anti-tumour necrosis factor treatment, patients receiving dialysis, patients preparing for organ or haematological transplantation, and patients with silicosis. In prisoners, healthcare workers, immigrants from high TB burden countries, homeless persons and illicit drug users, systematic testing and treatment of LTBI is conditionally recommended, according to TB epidemiology and resource availability. Either commercial interferon-gamma release assays or Mantoux tuberculin skin testing could be used to test for LTBI. Chest radiography should be performed before LTBI treatment to rule out active TB disease. Recommended treatment regimens for LTBI include: 6 or 9 month isoniazid; 12 week rifapentine plus isoniazid; 3-4 month isoniazid plus rifampicin; or 3-4 month rifampicin alone.

Topics: Antirheumatic Agents; Antitubercular Agents; Coinfection; Comorbidity; Disease Management; Drug Users; Emigrants and Immigrants; Evidence-Based Medicine; Health Personnel; HIV Infections; Humans; Ill-Housed Persons; Interferon-gamma Release Tests; Isoniazid; Kidney Failure, Chronic; Latent Tuberculosis; Mass Screening; Practice Guidelines as Topic; Prisoners; Public Health; Radiography, Thoracic; Renal Dialysis; Rifampin; Risk Assessment; Silicosis; Substance-Related Disorders; Transplant Recipients; Tuberculin Test; Tumor Necrosis Factor-alpha; World Health Organization

The discovery of rifampicin was the turning point away from the standard long term treatment for tuberculosis of 18 to 24 months and towards a 6-month curative programme. Rifampicin has proven to be highly effective and vital to short-course tuberculosis therapy, but its disadvantage is its cost. This makes it relatively unavailable where it is most needed, i.e. in countries where tuberculosis is still rampant, but which are economically underdeveloped. In such areas other needs take precedence over a chronic and non-spectacular medical condition like tuberculosis. During the past 10 years pyrazinamide has been 'rediscovered' and restudied, and when used in combination with rifampicin has been shown to play an important role in short-course chemotherapy. Its contribution to efficacy does not appear to extend beyond the first 2 months of therapy, and it should be discontinued after 2 months. This relatively short administration period helps to minimise adverse reactions to the drug. The main measure of success in short-course chemotherapy is the relapse rate, and this has been higher, sometimes unacceptably so, in regimens where bacteriostatic drugs were substituted for bactericidal ones. In conclusion, isoniazid, rifampicin and pyrazinamide in combination may be deemed essential to an effective short-course regimen of 6 months' duration. Curtailing the duration of treatment to less than 6 months in smear-positive tuberculosis results in high relapse rates and thus is not acceptable. Several studies have been undertaken varying the drug combinations, the dosages and the drug administration routines (i.e. whether daily followed by intermittent or intermittent throughout), in an effort to arrive at the simplest, most effective, least toxic and most economical all-round treatment programme. Such studies are still in progress. When recommended dosage regiments are followed, the incidence of adverse reactions is low with short-course therapy, and in only 5% or less of patients is it necessary to withdraw one or more drugs.

Topics: Drug Therapy, Combination; Humans; Pyrazinamide; Rifampin; Streptomycin; Substance-Related Disorders; Time Factors; Tuberculosis

Topics: Alcoholism; Analgesics; Anesthetics; Blood Proteins; Chronic Disease; Drug Interactions; Ethanol; Hormones; Humans; Immunity; Liver Diseases; Methadone; Prolactin; Respiration; Rifampin; Serum Albumin; Substance-Related Disorders; United States

Chicago Department of Public Health (CDPH), TB Control Program.. To compare anti-tuberculosis treatment outcomes using two different types of directly observed therapy (DOT) outreach workers.. Substance users diagnosed with TB from October 1996 to July 2000 were randomized to DOT administered by either 1) CDPH personnel (standard arm) or 2) previous substance-using human immunodeficiency virus/acquired immune-deficiency syndrome outreach workers (enhanced arm). Treatment completion was physician-determined, and adherence was estimated based on risk of missed DOT appointments.. Of 94 patients, 46 were randomized to the standard and 48 to the enhanced arm. The standard arm had a significantly higher risk of non-completion of treatment (39% vs. 15%, RR 2.7, 95%CI 1.2-5.8), and a significantly higher risk of missing DOT appointments (RR 2.6, 95%CI 1.4-4.8). For both outcomes, housing instability was a significant predictor in multivariate analyses.. TB treatment completion and adherence among substance users was improved by the enhanced intervention; the familiarity of enhanced-arm DOT workers with the patients' social norms due to their own previous substance use may have made them more effective. Successful DOT in hard-to-reach populations may require strategies that directly address the population's circumstances and utilize DOT workers who are intimately familiar with patients' life situations.

Topics: Adult; Antitubercular Agents; Directly Observed Therapy; Drug Users; Ethambutol; Ethnicity; Female; Humans; Isoniazid; Male; Patient Compliance; Pyrazinamide; Rifampin; Socioeconomic Factors; Substance-Related Disorders; Treatment Outcome; Tuberculosis

Topics: Aged; Antitubercular Agents; Deglutition Disorders; Delayed Diagnosis; Diagnosis, Differential; Directly Observed Therapy; Endoscopy, Digestive System; Esophageal Neoplasms; Esophagitis; Ethambutol; Fever; Humans; Isoniazid; Lymph Nodes; Lymphadenopathy; Male; Mexican Americans; Pyrazinamide; Rifampin; Substance-Related Disorders; Tomography, X-Ray Computed; Tuberculosis, Gastrointestinal; Ultrasonography

In conjunction with the spread of HIV infection, tuberculosis (TB) remains a major cause of illness and death worldwide. The Ethiopian national report reveals that extra pulmonary tuberculosis is on the rise and that case detection rate is exceeding that of smear positive or negative cases in many parts of the country. Different studies indicated that host and/or pathogen related factors are associated with the rise of extra pulmonary cases. However, the reason for this is not clearly known in our setting.. Specimens were taken from clinically suspected extra pulmonary patients and confirmed by cytology, histopathology and culture. Deletion typing and Spoligotyping was utilized to identify the strains. The isolates were then assigned to lineage using conformal Bayesian network (rules model) algorithm and dendrograms were drawn using UPGMA methods. In addition, drug sensitivity test was done using the indirect proportion and 24 well plate methods.. Out of the 200 clinically suspected extra pulmonary tuberculosis patients, 106 (53 %) were between 15 and 35 years of age and 167 (83.5 %) were new while 33 (16.5 %) were retreatment cases. The culture yield was 29.5 % (59). Of these only one was M. bovis and 58 were M. tuberculosis strains with 31 different spoligotype patterns grouped into seven clusters. The largest cluster (ST53) comprised 12 (20.3 %) isolates. There was higher clustering of CAS isolates in TBLN than in any other form of extra pulmonary tuberculosis cases. Resistance to rifampicin was higher (22 %) than that for INH, STM and EMB (8.1 %, 5 % and 3 % respectively). Out of the 37 isolates tested for resistance, only 2 isolates were resistant for both STM and INH and no MDR strain was found.. There is an ongoing active recent transmission among extra pulmonary tuberculosis in the study areas as shown by the presence of clusters. Although no MDR case was observed, there is a risk of emergence of MDR as noted from the high proportion of resistance to rifampicin. Detailed study at population level is recommended to monitor its trend.

Topics: Adolescent; Adult; Aged; Antitubercular Agents; Child; Child, Preschool; Coinfection; Drug Resistance, Bacterial; Ethiopia; Female; HIV Infections; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium tuberculosis; Retreatment; Rifampin; Substance-Related Disorders; Tuberculosis; Tuberculosis, Pulmonary; Young Adult

Severe liver injuries were attributed to the rifampin and pyrazinamide (RZ) regimen after it was recommended for treating latent tuberculosis infection. Implicating RZ as the likeliest cause required excluding alternative causes.. US health departments reported data on patients who died or were hospitalized for liver disease within 1 month after taking RZ for latent tuberculosis infection from October 1998 through March 2004. The circumstances were investigated on site for each case. Illness characteristics, reasons for RZ treatment, doses and frequency of administration of pyrazinamide, monitoring during treatment, and causes of liver injury were determined.. Liver injury was attributable to RZ use for all 50 patients reported, 12 of whom died. For 47 patients, RZ was the likeliest cause of liver injury. The median patient age was 44 years (range, 17-73 years). Thirty-two patients (64%) were male. Seven (16%) of 43 patients tested had hepatitis C virus antibodies, 1 (2%) of 45 had chronic hepatitis B, 3 (14%) of 22 had positive results of HIV serologic tests, 34 (71%) of 48 had alcohol use noted, and 33 (66%) of 50 were taking additional hepatotoxic medications. Six patients, 2 of whom died, had no predictors for liver disease. Patients who died were older (median age, 52 vs. 42 years; P=.08) and took a greater number of other medications (median number of medications, 4 vs. 2; P=.05) than did those who recovered, but these 2 factors were correlated (P<.01). Thirty-one patients (62%) were monitored according to guidelines, 9 of whom died.. RZ was the likeliest cause of most of these liver injuries, some of which were fatal in spite of monitoring. Fatality was predicted by age or use of other medications, but none of the cofactors showed promise as a reliable clinical predictor of severe liver injury.

Topics: Adolescent; Adult; Aged; Alcohol Drinking; Antitubercular Agents; Chemical and Drug Induced Liver Injury; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Pyrazinamide; Rifampin; Risk Factors; Substance-Related Disorders; Tuberculosis; United States

Topics: Adult; Bronchopneumonia; Drug Interactions; Female; Humans; Methadone; Rifampin; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Aminosalicylic Acids; Drug Resistance, Microbial; Drug Therapy, Combination; England; Humans; Isoniazid; Rifampin; Staphylococcal Infections; Streptomycin; Substance-Related Disorders; Tuberculosis