Toxicologic and Pharmacologic Aspects of Rifampin

Experience indicates that rifampin is a semisynthetic antibiotic highly active against mycobacteria, which can be administered orally once daily, resulting in prolonged high blood levels considerably above those needed to inhibit Mycobacterium tuberculosis. There is no cross-resistance to other antimicrobial agents, and it is relatively nontoxic with the proper selection of patients. It is capable of sterilizing lungs and spleens of experimental animals when combiied with isoniazid, opening the door to studies of effective intermittent therapy regimens in tuberculosis. Because of lack of cross-resistance with other drugs used in the treatment of tuberculosis, its obvious place in the therapeutic armamentarium is the treatment of resistant infections and treatment failures when combined with other appropriate drugs. However, the advantage of the more rapid sputum conversion when using regimeus containing rifampin should be an advantage for its use in initial treatment, particularly when resistant organisms are suspected or when there is intolerance or toxicity to other effective drugs. For the present, we have the opportunity to study its long-term actions, interactions with other pharmacologic agents and the best selection of patients for rifampin therapy. Whether its high degree of efficacy when combined with isoniazid will permit shortening of the duration of therapy is much too early to answer. Only long periods of observation in planned control studies will answer that question. The addition of rifampin to our therapeutic regimens in the treatment of tuberculosis will alter the duration of hospitalization, if not the need for it, in more patients. Properly used, it should reduce sharply the number of treatment failures.

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