rifampin and Uveitis

Rifamycins are an essential component of modern short-course regimens for treating tuberculosis. Rifabutin has favourable pharmacokinetic and pharmacodynamic properties and is less prone to drug-drug interactions than rifampicin. It could contribute to shortening of therapy or simplify treatment in HIV-positive people who also need antiretroviral drugs.. To compare combination drug regimens containing rifabutin with those containing rifampicin for treating pulmonary tuberculosis. We searched Cochrane Infectious Diseases Group Specialized Register (January 2007), CENTRAL (The Cochrane Library 2006, Issue 4), MEDLINE (1966 to January 2007), EMBASE (1974 to January 2007), and LILACS (1982 to January 2007). We also searched the Indian Journal of Tuberculosis (1983 to 2006), conference abstracts, reference lists, and unpublished data on file at Pfizer Inc.. Randomized and quasi-randomized trials including participants with sputum smear and/or culture-confirmed tuberculosis that compared a rifabutin-containing with an otherwise identical rifampicin-containing regimen.. Two authors independently assessed study eligibility and methodological quality, and extracted data. Dichotomous data were analysed and combined using relative risks (RR) with 95% confidence intervals (CI) using a fixed-effect model. Subgroup analyses were carried out according to rifabutin dose.. Five trials with a total of 924 participants met the inclusion criteria; 5% of participants were HIV positive. Only one small trial was methodologically adequate. The two largest trials (818 participants) had unclear allocation concealment and included < 90% of randomized participants in the analysis. There was no statistically significant difference in between the regimens for cure (RR 1.00, 95% CI 0.96 to 1.04; 553 participants, 2 trials) or relapse (RR 1.23, 95% CI 0.45 to 3.35; 448 participants, 2 trials). The number of adverse events was not significantly different (RR 1.42, 95% CI 0.88 to 2.31; 714 participants, 3 trials), though the RR increased with rifabutin dose: 150 mg (RR 0.98, 95% CI 0.45 to 2.12; 264 participants, 2 trials); and 300 mg (RR 1.78, 95% CI 0.94 to 3.34; 450 participants, 2 trials). However, lack of dose adjustment by weight in the relevant trials complicates interpretation of this relationship.. The replacement of rifampicin by rifabutin for first-line treatment of tuberculosis is not supported by the current evidence. HIV-positive people with tuberculosis, the group most likely to benefit from the rifabutin use, are under-represented in trials to date, and further trials in this group would be useful.

Topics: Antibiotics, Antitubercular; Humans; Randomized Controlled Trials as Topic; Rifabutin; Rifampin; Tuberculosis, Pulmonary; Uveitis

Bacteremia with the Mycobacterium avium complex is common in patients with the acquired immunodeficiency syndrome (AIDS), but the most effective treatment for this infection remains unclear.. We randomly assigned 229 patients with AIDS and M. avium complex bacteremia to receive either rifampin (600 mg daily), ethambutol (approximately 15 mg per kilogram of body weight daily), clofazimine (100 mg daily), and ciprofloxacin (750 mg twice daily) (the four-drug group) or rifabutin (600 mg daily), ethambutol (as above), and clarithromycin (1000 mg twice daily) (the three-drug group). In the three-drug group the dose of rifabutin was reduced by half after 125 patients were randomized, because 24 of 63 patients had uveitis.. Among 187 patients who could be evaluated, blood cultures became negative more often in the three-drug group than in the four-drug group (69 percent vs. 29 percent, P<0.001). Among patients treated for at least four weeks, the bacteremia resolved more frequently in the three-drug group (78 percent vs. 40 percent, P<0.001). In the three-drug group, bacteremia resolved more often with the 600-mg dose of rifabutin than with the 300-mg dose (P=0.025), but the latter regimen was more effective than the four-drug regimen (P<0.05). The median survival was 8.6 months in the three-drug group and 5.2 months in the four-drug group (P = 0.001). The median Karnofsky performance score was higher in the three-drug group than in the four-drug group from week 2 to week 16 (P<0.05). Mild uveitis developed in 3 of the 53 patients receiving the 300-mg dose of rifabutin, an incidence about one quarter that observed with the 600-mg dose (P<0.001).. In patients with AIDS and M. avium complex bacteremia, treatment with the three-drug regimen of rifabutin, ethambutol, and clarithromycin leads to resolution of the bacteremia more frequently and more rapidly than treatment with rifampin, ethambutol, clofazimine, and ciprofloxacin, and survival rates are better.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Antitubercular Agents; Bacteremia; Ciprofloxacin; Clarithromycin; Clofazimine; Drug Therapy, Combination; Ethambutol; Female; Humans; Male; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifabutin; Rifampin; Survival Analysis; Treatment Outcome; Uveitis

To describe the clinical features of patients with uveitis associated with latent tuberculosis (TB) and examine the effect of anti-TB treatment (ATT) on uveitis outcome.. Retrospective cohort study.. One hundred ninety-nine eyes of 129 patients diagnosed with uveitis associated with latent TB were evaluated for recurrence of disease following treatment. Eighty-nine of the patients (69%) received ATT and information was gathered retrospectively regarding clinical outcome, vision, and treatment. Outcome measures included best-corrected visual acuity (BCVA) and rate of disease recurrence.. This study included 89 patients (69%) who received ATT and 40 patients who did not. The uveitis was treated with local and systemic anti-inflammatory and immunosuppressive therapy in all patients. The mean change in BCVA following treatment was 4.5 ± 1.4 letters over the follow-up period, with no difference between eyes of patients receiving ATT and those who did not. Sixty-eight eyes (34.9%) had a recurrence of uveitis (0.64 ± 0.08 recurrences per year), with eyes of patients receiving ATT less likely to develop a recurrence compared to those not receiving ATT (29.5% vs 48.2%, odds ratio 0.47, 95% confidence interval 0.29-0.77, P = .003). Eyes treated with ATT recurred at an estimated median of 120 months, compared with 51 months in eyes with no treatment (P = .005).. Treatment with ATT halved the risk of uveitis recurrence and delayed the onset of the first recurrence in eyes with uveitis associated with latent TB.

Topics: Adolescent; Adult; Aged; Antitubercular Agents; Child; Child, Preschool; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Glucocorticoids; Humans; Immunosuppressive Agents; Interferon-gamma Release Tests; Isoniazid; Latent Tuberculosis; Male; Middle Aged; Pyrazinamide; Recurrence; Retrospective Studies; Rifampin; Treatment Outcome; Tuberculosis, Ocular; Uveitis; Visual Acuity

Topics: Animals; Anti-Bacterial Agents; Brucellosis; Doxycycline; Drug Therapy, Combination; Endemic Diseases; Eye Infections, Bacterial; Humans; Retinal Hemorrhage; Rifampin; Streptomycin; Uveitis; Zoonoses

To evaluate clinical and paraclinical parameters for the indirect diagnosis of tuberculosis-related uveitis (TRU).. Prospective 2-year study in a tertiary referral centre. Patients with clinically suspected TRU were recruited. Demographical and clinical data were recorded. QuantiFERON(®) -TB Gold (QFT), tuberculosis skin test (TST) and pulmonary X-ray were performed, and other possible uveitis aetiologies were ruled out. Further investigations were also performed case by case after consultation. After final assessment, standard antituberculosis therapy was started if TRU was considered highly probable. Finally, diagnosis of TRU was established according to current criteria and set as gold standard. Strength of association for TRU was determined by odds ratio and compared by appropriate tests. Concordance and binary classification tests were also assessed..   The study included 103 patients, 54 men and 49 women. Mean age 45.6 years. Sixty-eight patients were Spanish-born and 35 were foreign-born. Final diagnosis included 33 (32%) cases of TRU and 70 (67%) cases with other diagnoses. Asian origin (OR = 3.50, p = 0.046), previous tuberculosis (TB) contact (OR = 2.61, p = 0.026), TB in the past (OR = 6.18, p = 0.004) and associated retinal vasculitis (OR = 7.85, p < 0.001) were significantly related to TRU. Sensitivity (S) and specificity (Sp) of the TST and QFT did not differ significantly (S 87% versus 90% and Sp 85% versus 82%, respectively) with fair agreement (k = 0.607).. In a Western urban multi-ethnic population, patients from Asia, TB history or contact in the past and vasculitis are at higher risk of TRU. TST and QF are complementary providing enough S and Sp to support the diagnosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antitubercular Agents; Child; Drug Therapy, Combination; Ethambutol; Female; Glucocorticoids; Humans; Interferon-gamma Release Tests; Isoniazid; Male; Middle Aged; Prednisone; Prospective Studies; Pyrazinamide; Racial Groups; Radiography, Thoracic; Rifampin; Risk Factors; Sensitivity and Specificity; Spain; Surveys and Questionnaires; Tuberculin Test; Tuberculosis, Ocular; Urban Population; Uveitis; Young Adult

To characterize the clinical features of ocular Whipple's disease (WD) and determine the long-term prognosis after antibiotic treatment.. Retrospective case series.. Medical records of patients referred between January 1993 and December 2010 were reviewed for chronic corticosteroid-resistant uveitis or neuro-ophthalmologic findings consistent with WD. Eleven patients (male/female = 9/2) were included in this study.. Diagnosis was based on cytologic examination and molecular analysis of samples (cerebrospinal fluid, vitreous, duodenum, or any involved lymph node). It was based on cytology before the routine use of polymerase chain reaction (PCR) and on both cytology and molecular biology for more recent patients. Long-term antibiotic therapy included oral trimethoprim-sulfamethoxazole (TMP-SMX) and rifampin, TMP-SMX alone, rifampin alone, or tetracycline alone.. (1) Demographic and clinical characteristics of patients with positive PCR for Tropheryma whipplei or periodic acid-Schiff-positive macrophages in the vitreous and (2) long-term prognosis after antibiotic treatment.. Mean age at diagnosis was 63 years (range, 51-73 years). Average time between the onset of the disease and diagnosis was 2 years (range, 1 month to 11 years). Mean follow-up was 7.2 years (range, 0.25-18 years). Ophthalmologic findings consisted of chronic uveitis (9 patients), isolated bilateral optic disc swelling (1 patient), and Parinaud syndrome (1 patient). All patients had PAS-positive macrophages, and 6 patients had a positive PCR for T. whipplei. Nine patients were treated with TMP-SMX and rifampin. One patient treated with only tetracycline relapsed and was successfully treated with TMP-SMX. No major side effects were reported. Intraocular inflammation and neurologic manifestations were controlled in all cases. At the end of follow-up, 2 patients were off treatment, 2 patients had a neurologic relapse after treatment interruption, and 5 patients were still taking TMP-SMX. One patient was taking only rifampin. Two patients were lost to follow-up.. Ocular WD seems to be a neurologic manifestation of WD. Trimethoprim-SMX with rifampin is an efficient treatment, and prolonging treatment for at least 1 year is recommended. Long-term low-dose antibiotic therapy may reduce the rate of relapse, neurologic involvement, and death.

Topics: Aged; Anti-Infective Agents; Cerebrospinal Fluid; Drug Resistance; Drug Therapy, Combination; Enzyme Inhibitors; Eye Infections, Bacterial; Female; Fluorescein Angiography; Follow-Up Studies; Glucocorticoids; Humans; Lymph Nodes; Male; Middle Aged; Polymerase Chain Reaction; Prognosis; Retrospective Studies; Rifampin; RNA, Bacterial; RNA, Ribosomal, 16S; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Uveitis; Vitreous Body; Whipple Disease

Topics: Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Humans; Male; Pyrazinamide; Rifampin; Tuberculosis, Ocular; Uveitis; Young Adult

Topics: Antitubercular Agents; Area Under Curve; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; False Positive Reactions; Humans; Interferon-gamma; Isoniazid; Lung; Predictive Value of Tests; Pyrazinamide; Radiography; Reagent Kits, Diagnostic; Rifampin; ROC Curve; Sensitivity and Specificity; Tuberculin Test; Tuberculosis, Ocular; Uveitis

Topics: Antitubercular Agents; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; Humans; Interferon-gamma; Isoniazid; Lung; Predictive Value of Tests; Pyrazinamide; Radiography; Rifampin; ROC Curve; Sensitivity and Specificity; Tuberculin Test; Tuberculosis, Ocular; Uveitis

To determine the role of the QuantiFERON-TB Gold In-Tube (QFT) (Cellestis Inc., Carnegie, Australia) assay in the diagnosis of tuberculosis (TB) uveitis.. Retrospective cohort study.. The study included 157 patients with suspected TB uveitis seen over an 18-month period (August 1, 2006, to February 31, 2007) at the Singapore National Eye Center (SNEC) uveitis clinic.. We identified all cases of suspected TB uveitis in the above-mentioned time period and reviewed all medical records of the cases. Clinical findings, type of treatment instituted, response to treatment, and results of investigations such as QFT, tuberculin skin test (TST), and chest x-rays were recorded. A novel method of using treatment response to determine the presumed diagnosis of TB was used to estimate the accuracy of QFT and TST.. The positive likelihood ratio (LR+), negative likelihood ratio (LR-), and area under the receiver operator characteristic curve (ROC) of the investigations were estimated.. QFT is not superior to the TST in sensitivity as a screening test or first-line study in TB-related uveitis; however, QFT is more specific than the TST in identifying infections by Mycobacterium tuberculosis. Negative QFT tests should be interpreted with caution, because they do not exclude the diagnosis.. The new QFT is only slightly superior to the TST in the diagnosis of TB uveitis. Thus, there is an important role for interpreting the QFT together with the TST. This is the first and largest study of its kind to evaluate the use of QFT in the clinical diagnosis of TB uveitis.

Topics: Adult; Antitubercular Agents; Area Under Curve; Drug Therapy, Combination; Enzyme-Linked Immunosorbent Assay; False Positive Reactions; Female; Humans; Interferon-gamma; Isoniazid; Lung; Male; Middle Aged; Predictive Value of Tests; Pyrazinamide; Radiography; Reagent Kits, Diagnostic; Retrospective Studies; Rifampin; ROC Curve; Sensitivity and Specificity; Tuberculin Test; Tuberculosis, Ocular; Uveitis

Topics: Adult; Antigens, Bacterial; Dapsone; Facial Dermatoses; Fever; Humans; Leprostatic Agents; Leprosy, Borderline; Male; Mycobacterium leprae; Peripheral Nervous System Diseases; Philippines; Prednisone; Rifampin; Uveitis

Papulonecrotic tuberculids represent an immunological expression of an internal focus of tuberculosis in an individual with a moderate or high degree of immunity. It responds to anti-tuberculosis treatment and is characterized by an eruption of necrotizing papules occurring in symmetrical crops, particularly affecting the elbows, knees, buttocks and face. A case of papulonecrotic tuberculids associated with immune mediated unilateral uveitis is reported in which all investigations were negative for tuberculosis except a strongly positive tuberculin test. There was an excellent response to anti-tuberculosis treatment. The association of immune mediated uveitis with papulonecrotic tuberculids has not been described before.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Glucocorticoids; Humans; Isoniazid; Male; Ophthalmic Solutions; Pyrazinamide; Rifampin; Tuberculin Test; Tuberculosis, Cutaneous; Tuberculosis, Ocular; Uveitis

To evaluate the results of tuberculin skin testing in Japanese patients with intraocular inflammation and to assess the outcome of treatment for presumed intraocular tuberculosis in selected patients.. Prospective, noncomparative, interventional case series.. One hundred twenty-six patients, newly referred to the Ocular Inflammation Service at the Kyorin Eye Center from April 1998 to August 2000, underwent systemic evaluation for the diagnosis and/or treatment of uveitis.. Tuberculin skin testing with purified protein derivative was performed as part of the systemic evaluation. The diagnosis of presumed intraocular tuberculosis was made when findings were consistent with possible intraocular tuberculosis, the tuberculin skin test was positive (induration more than 10 mm), and no other cause of uveitis was suggested by symptoms, signs, or ancillary testing. Using these criteria, 10 patients were given a diagnosis of presumed intraocular tuberculosis and treated with antituberculosis therapy consisting of isoniazid, with or without rifampicin. Some of these patients also received a tapered course of oral corticosteroids after the initiation of antituberculosis treatment. None of the patients had any signs or symptoms of acquired immunodeficiency syndrome.. Visual acuity and ophthalmologic examination to assess degree of intraocular inflammation.. Twenty-six of the 126 patients (20.6%) had a positive tuberculin skin test result. Ten of these 26 patients (38.5%) were treated for a diagnosis of presumed intraocular tuberculosis. Nine patients had no evidence of pulmonary tuberculosis, and one patient had presumed tuberculous hilar lymphadenitis. The predominant clinical finding was choroidal or optic disc nodule in three patients, retinal vasculitis in three patients, and choroiditis in four patients. Nine patients exhibited decreased intraocular inflammation with treatment.. Roughly one fifth of the uveitis patients who underwent systemic evaluation had a positive tuberculin skin test result, and 9 of 10 selected skin test-positive patients with clinical findings consistent with intraocular tuberculosis had a favorable response to antituberculosis therapy. These results suggest that intraocular tuberculosis continues to be a major diagnostic consideration for uveitis patients in Japan.

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Female; Fluorescein Angiography; Fundus Oculi; Glucocorticoids; Humans; Isoniazid; Japan; Male; Middle Aged; Prospective Studies; Rifampin; Tuberculin Test; Tuberculosis, Ocular; Uveitis; Visual Acuity

A highly selective technique of polymerase chain reaction (PCR) was performed for detection of Mycobacterium tuberculosis from aqueous samples of 45 patients to evaluate its role in initiating antituberculosis treatment in patients with presumed intraocular tuberculosis.. Forty-five patients were divided into three groups. Group I included 17 patients of presumed intraocular tuberculosis, group II 13 disease controls and group III had 15 normal controls. Patients with positive PCR were offered antituberculosis chemotherapy and followed up for a minimum of 18 months.. Ten patients in group I, 3 in group II and none in group III were positive for Mycobacterium tuberculosis by PCR. Ten patients with positive PCR for Mycobacterium tuberculosis (8 in group I and 2 in group II) were treated with antituberculosis chemotherapy and all showed resolution of inflammation without any recurrence over 18 months of follow-up. Two PCR positive patients treated with steroids alone, however, did not show complete resolution and had recurrent attacks.. These results suggest that antituberculosis treatment in PCR positive patients leads to resolution of inflammation and elimination of recurrences, most likely by eliminating Mycobacterium tuberculosis from the intraocular tissues.

Topics: Adolescent; Adult; Antibiotics, Antitubercular; Aqueous Humor; Child; DNA Primers; DNA, Bacterial; Female; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Polymerase Chain Reaction; Pyrazinamide; Rifampin; Tuberculin Test; Tuberculosis, Ocular; Uveitis

Topics: Aged; Anti-Bacterial Agents; Choroiditis; Drug Resistance, Microbial; Drug Therapy, Combination; Ethambutol; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Prednisone; Pyrazinamide; Rifampin; Sputum; Tuberculosis, Ocular; Uveitis; Visual Acuity

Two cases of acute uveitis have been reported in reversal reactions in lepromatous patients treated with anti-hansenian multidrug therapy with daily rifampicin. This type of eye damage has seldom been reported in reversal reactions.

Topics: Acute Disease; Clofazimine; Drug Combinations; Ethionamide; Female; Humans; Leprosy, Lepromatous; Male; Middle Aged; Rifampin; Uveitis

Idiopathic Uveitis (IU) may occur as either an isolated ocular disease or with other systemic diseases such as Crohn's Disease (CD). As many as 33% of CD patients demonstrate IU, and frequently their gut and IU course and severity are similar. Rifampin produces remissions of isolated IU, and Rifampin has been used to treat gut CD with varying success. In this investigation 4 CD patients, whose gut but not IU had partially responded to corticosteroids, the addition of Rifampin was associated with improvement in both their CD Activity Index and IU, allowing steroid discontinuation; Rifampin withdrawal was associated with exacerbations of both gut disease and IU; and re-institution of Rifampin was associated with another gut and IU disease remission. Since mouse ocular and systemic inflammatory disease producing non-cultivatable ultrastructurally unusual bacteria are commonly found within isolated chronic IU vitreous polymorphonuclear (PMN) leukocytes, a search for these bacteria in CD eye and gut disease seems justified, as the beneficial results of Rifampin in this study may have been an antimicrobial action on these bacteria.

Topics: Adult; Crohn Disease; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Male; Prednisone; Rifampin; Uveitis; Visual Acuity

Topics: Adult; Burns; Cell Count; Cerebrospinal Fluid; Cerebrospinal Fluid Proteins; Drug Therapy, Combination; Ethambutol; Humans; Kanamycin; Lymphocytes; Male; Mycobacterium; Prednisolone; Pyrazinamide; Rifampin; Tuberculosis, Meningeal; Tuberculosis, Pulmonary; Uveitis

Topics: Adult; Aged; Chorioretinitis; Choroiditis; Eye Diseases; Female; Humans; Male; Middle Aged; Optic Neuritis; Retinitis; Rifampin; Tuberculosis, Ocular; Uveitis; Uveitis, Anterior