Adult Dosing
Tuberculosis
- 10 mg/kg IV daily for 4-6 months [Max: 600 mg/day]
- Note: Rifampin is to be given as a part of multi-drug regimen. A 3-drug regimen consisting of rifampin, isoniazid and pyrazinamide is recommended for initial phase of short-course therapy. Streptomycin/ethambutol may be added as a fourth drug if community rates for isoniazid resistance >4%
Meningococcal prophylaxis, asymptomatic carriers
- 600 mg IV q12 hrs for 2 days
Orbital cellulitis [Non-FDA Approved]
- 20 mg/kg/day IV divided q12h (maximum 600 mg per day)
Pediatric Dosing
Tuberculosis
- 10-20 mg/kg/day [Max: 600 mg/day]
- Note: Rifampin is to be given as a part of multi-drug regimen. A 3-drug regimen consisting of rifampin, isoniazid and pyrazinamide is recommended for initial phase of short-course therapy. Streptomycin/ethambutol may be added as a fourth drug if community rates for isoniazid resistance >4%
Meningococcal prophylaxis, asymptomatic carriers
- Child (
1 month): 10 mg/kg IV q12 hrs x 2 days. [Max: 600 mg/dose] - Child (<1 month): 5 mg/kg IV q12 hrs x 2 days. [Max: 600 mg/dose]
H. influenzae prophylaxis [Not FDA approved]
- Child (<1 month): 10 mg/kg IV q24 hrs x 4 days; Max: 600 mg/day
- Child (1 month): 20 mg/kg PO/IV q24 hrs x 4 days; Max: 600 mg/day
Orbital cellulitis [Non-FDA Approved]
- 20 mg/kg/day IV divided q12h (maximum 600 mg per day)
[Outline]
See Supplemental Patient Information
- To reduce the development of drug-resistant bacteria and maintain the effectiveness of therapy, rifampin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
- Rifampin is known to cause fatalities associated with jaundice in patients with liver disease and in patients taking rifampin with other hepatotoxic agents, so should be given only in cases of necessity with caution and under strict medical supervision
- Discontinue the drug if there are signs of hepatocellular damage
- It is not indicated for the treatment of meningococcal infection because of the possibility of the rapid emergence of resistant organisms so restrict its use for short-term treatment of the asymptomatic carrier state
- Intermittent therapy is not recommended as it can cause rare renal hypersensitivity reactions when therapy is resumed in such cases
- Hepatic enzymes, bilirubin, serum creatinine, a complete blood count, and a platelet count measurement should be done at the base line
Cautions: Use cautiously in
- Hepatic impairment
- History of diabetes mellitus
- Concurrent use of other hepatotoxic agents
- Porphyria
- Elderly patients
- Concomitant use with maraviroc not recommended, adjust dose if clinically warranted
Supplemental Patient Information
- Patients are warned against Skipping doses or not completing the full course of therapy as it may lead to decrease in the effectiveness of the immediate treatment and will also increase the likelihood that bacteria to develop resistance and will not be treatable by rifampin or other antibacterial drugs in the future
- Rifampin may produce a reddish coloration of the urine, sweat, sputum, and tears
- Patient are advised to use alternative contraceptive measures as the reliability of oral or other systemic hormonal contraceptives may be affected
- Patients are advised to take drug either 1 hour before or 2 hours after a meal with a full glass of water
- Patients should immediately contact their physicians if they experience fever, loss of appetite, malaise, nausea and vomiting, darkened urine, yellowish discoloration of the skin and eyes, and pain or swelling of the joints
Pregnancy Category:C
Breastfeeding: Women with tuberculosis who have been treated for >2 wks and who are not considered contagious may breastfeed. Limited information indicates that rifampin is excreted in breastmilk in low levels and thus would not be expected to adversely affect the breastfed infant. The amount of rifampin in milk is insufficient to treat tuberculosis in the breastfed infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 23 November 2010). Manufacturer recommends discontinuation of breastfeeding or discontinuation of drug taking into account the importance of the drug to the mother.
