Rifampin
General
- Type: bactericidal antibiotic
- Dosage Forms: 150, 300; PO, IV
- Common Trade Names: Rifadin
Adult Dosing
Active TB
- 10mg/kg/day (in combination with isoniazid and pyrazinamide) PO or IV for 2 months
- Then 10mg/kg/day (in combination with isoniazid) for 4 months or longer as needed
- MAX, 600mg/day
Inactive TB, HIV+
- 600mg PO daily for 4 months
Meningitis
- 600mg IV once daily (with vancomycin/cephalosporin)
Bartonellosis
- 300mg PO or IV q12h plus doxycycline
Brucellosis
- 15-20mg/kg/day PO/IV in 1 or 2 divided doses for at least 6 weeks in combination with a tetracycline
- MAX 600 to 900mg/day
Infective endocarditis
- 300mg IV or PO every 8 hours for a minimum of 6 weeks, in combination with appropriate antimicrobial therapy
Hansen Disease
- Paucibacillary, single lesion
- 600 mg PO x1 with ofloxacin and minocycline
- Paucibacillary
- 600 mg PO qmo x 6mo with dapsone
- Multibacillary
- 600 mg PO qmo x 12mo with dapsone and clofazimine
Anthrax, systemic
- 600 mg IV q12h for at least 2 wk as part of a multi-drug regimen
- Switch to PO abx x60 days total if inhalational exposure
Pediatric Dosing
Active TB
- <15 yo
- 10-20 mg/kg PO/IV qd for at least 6mo
- Max: 600 mg/day
- 10-20 mg/kg PO/IV qd for at least 6mo
- 15+ yo
- 10 mg/kg PO/IV qd for at least 6mo
- Max: 600 mg/day
- 10 mg/kg PO/IV qd for at least 6mo
Latent TB
- <15 yo
- 10-20 mg/kg PO/IV qd x4mo
- Max: 600 mg/day
- 10-20 mg/kg PO/IV qd x4mo
- 15+ yo
- 10 mg/kg PO/IV qd x4mo
- Max: 600 mg/day
- 10 mg/kg PO/IV qd x4mo
H. influenza prophylaxis
- <1 mo
- 10mg/kg PO/IV q24h x4 days
- Max: 600 mg/day
- 10mg/kg PO/IV q24h x4 days
- 1+ mo
- 20 mg/kg PO/IV q24h x4 days
- Max: 600 mg/day
Meningcococcal prophylaxis
- <1 mo
- 5mg/kg PO/IV q24h x4 days
- Max: 600 mg/day
- 5mg/kg PO/IV q24h x4 days
- 1+ mo
- 10 mg/kg PO/IV q24h x4 days
- Max: 600 mg/day
Endocarditis, Staphylococcal prosthetic valve
- 20 mg/kg/day PO/IV divided q8h for at least 6wk with gentamicin and nafcillin
- Max 900 mg/day
Hansen Disease
- Paucibacillary, 10-14 yo
- 450mg PO qmo x6mo with dapsone
- Paucibacillary, 15+ yo
- 600 mg PO qmo x 6mo with dapsone
- Multibacillary, 10-14 yo
- 450mg PO qmo x 12mo with dapsone and clofazimine
- Multibacillary, 15+ yo
- 600 mg PO qmo x 12mo with dapsone and clofazimine
Anthrax, systemic
- Neonates >32 wk gestation
- 10-20 mg/kg/day IV divided q12-24h for at least 2 wk as part of multi-drug regimen
- 1+ mo
- 20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen
- Max: 300 mg/dose
- 20 mg/kg/day IV divided q12h for at least 2 wk as part of multi-drug regimen
Special Populations
- Pregnancy Rating: C
- Lactation: Infant risk minimal
- Renal Dosing:
- Adult
- CrCl <50: Consider decreasing dose 0-50%
- HD/PD: No supplment
- Pediatric
- CrCl <50: Consider decreasing dose 0-50%
- HD/PD: No supplment
- Adult
- Hepatic Dosing
- Adult
- Avoid Use
- Pediatric
- Avoid Use
- Adult
Contraindications
- Allergy to class/drug
- IM or SC administration
- Concomitant use with atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, rilpivirine or elvitegravir/cobicistat
Adverse Reactions
Serious
- Agranulocytosis
- DIC
- Hepatotoxicity
- Nephrotoxicity
- Thrombocytopenia
- Leukopenia
- Anemia
- Porphyria exacerbation
- Erythema multiforme
- Stevens-Johnson Syndrome
- Toxic epidermal necrolysis
- C. Diff associated diarrhea
- Psychosis
Pharmacology
- Half-life: 3-5hr, 2-3hr with repeat dosing
- Metabolism: Hepatic
- Excretion: Bile; Urine <30%
- Mechanism of Action: inhibits bacterial RNA synthesis
Antibiotic Sensitivities[1]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- Sanford Guide to Antimicrobial Therapy 2014
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