Rifampicin

Rifampicin capsules

Rifampicin (R)

Rifampicin is one of four drugs taken as part of a standard treatment regimen for TB. Rifampicin, discovered in 1957, remains one of the strongest medications available for TB treatment. Patients that are resistant to both rifampicin and isoniazid have MDR TB.

Dosage:

How it works:

Rifampicin is a bactericidal antibiotic drug derived from a compound from Amycolatopsis rifamycinica. It inhibits DNA-dependentRNA polymerase, thus inhibiting transcription to RNA, making the bacterium unable to produce important proteins.

Side effects and interactions:

Rifampicin can cause hepatitis (inflammation of the liver), anorexia, nausea, mild abdominal pain, vomiting and itching. When taken intermittently, rifampicin can also cause flu-like symptoms such as fever, chills, malaise, headaches and bone pains. Rifampicin colours body secretion (tears, sweat, semen and urine) orange or red.

Rifampicin reduces the effectiveness of oral contraceptives. Patients may need to be given a higher dose of oral contraceptive or switched to a different method of contraception, such as condoms.

Rifampicin can reduce the concentration of the following antiretrovirals in the body: nevirapine, efavirenz, lopinovir and ritonavir.

Clinical evidence and approval:

Rifampicin was discovered in 1957 and received approval for therapeutic use in 1968 as part of a combination of medicines to treat TB. Prior to receiving approval, a number of trials established the safety and efficacy of rifampicin.

Initial reports on the efficacy on Rifampicin were published in Italian and French. With encouraging evidence coming out of Europe, two pilot studies were undertaken in six Veteran's Administration (VA) hospitals in the US. The first VA study in 1968 was carried out on patients with advanced TB who had already experienced treatment failure on other anti TB medications available at the time. This study aimed to clarify dosages at which patients would be susceptible to rifampicin.¹

The second pilot study, carried out in 1969 on treatment-naive patients, compared regimens of streptomycin and isoniazid, isoniazid and rifampicin, and isoniazid and rifampicin: 92% vs 98% vs 88%, respectively, had negative cultures at 6 months.²

In 1972, a retrospective study was published looking at 200 patients previously treated with rifampicin. Of 200 patients, 67 were treated with rifampcin and isoniazid alone, and the rest were treated with the addition of either streptomycin or ethambutol. 100% of patients became sputum negative by 120 days.³

Countless other trials have been carried out and today rifampicin is used in combination with isoniazid, ethambutol and pyranzinamide to treat drug-susceptible TB.

Rifampicin is available in the following fixed dose combinations:

Rimstar – R (150 mg)/ H (75 mg)/ P (400 mg)/ E (275 mg)

Rimcure – R (150 mg)/ H (75 mg)/ P (400 mg)

Rimcure PAED - R (60 mg)/ H (30 mg)/ P (150 mg)

Rimactazid 150/75 - R (150 mg)/ H (75 mg)

Rimactazid 300/150 - R (300 mg)/ H (150 mg)

Rimactazid PAED - R (60 mg)/ H (60 mg)

Pricing (per lowest unit, i.e. single tablet or injection):

* Private sector prices sourced on 26/07/11. Global Drug Facility prices converted to rands on 26/07/11.

* Private and public sector prices may vary between suppliers. The lowest available prices are shown here.

Advocacy issues:

• Rifampicin is affordable and supply is secure. Rifampicin is also available in fixed dose combinations and paediatric formulations.