Pharmacologic Profile

General Use

To treat and prevent tuberculosis. Combinations are used in the treatment of active tuberculosis to rapidly ↓ the infectious state and delay or prevent the emergence of resistant strains. In selected situations, intermittent (twice weekly) regimens may be employed. Rifampin is also used in the prevention of meningococcal meningitis and Haemophilus influenzae type B and in treatment of S. aureus infections (in combination with other antimicrobial agents).

General Action and Information

Kill or inhibit the growth of mycobacteria responsible for causing tuberculosis. Combination therapy with ≥2 agents is required, unless used as prophylaxis (isoniazid alone).

Contraindications

Hypersensitivity. Severe liver disease.

Precautions

Use cautiously in patients with a history of liver disease or in older adults. Ethambutol requires ophthalmologic follow-up. Compliance is required for optimal response.

Interactions

Isoniazid inhibits the metabolism of phenytoin. Rifampin significantly ↓ levels of many drugs.

Nursing Implications

Assessment

• Mycobacterial studies and susceptibility tests should be performed prior to and periodically throughout therapy to detect possible resistance.
• Assess lung sounds and character and amount of sputum periodically throughout therapy.

Implementation

• Most medications can be administered with food if GI irritation occurs.

Patient/Family Teaching

• Advise patient of the importance of continuing therapy even after symptoms have subsided.
• Emphasize the importance of regular follow-up exams to monitor progress and check for side effects.
• Inform patients taking rifampin that saliva, sputum, sweat, tears, urine, and feces may become red-orange to red-brown and that soft contact lenses may become permanently discolored.

Evaluation/Desired Outcomes

• Resolution of the signs and symptoms of tuberculosis. Negative sputum cultures.