Rates and risk factors for discontinuation of rifampicin
Abstract:SETTING: All patients with culture-confirmed, rifampin-susceptible Mycobacterium tuberculosis diagnosed during a 20-month period in New York City, who were started on a rifampin-containing regimen and received ≥60 days of treatment.
OBJECTIVE: To identify rates of and reasons for rifampin discontinuation.
DESIGN: Retrospective case-control study using surveillance data and medical record reviews. Discontinuation due to thrombocytopenia, creatinine >2.0 mg/dl, bilirubin >2.0 mg/dl or severe reactions (generalized rash, persistent drug fever, or severe interference with methadone metabolism) were defined as appropriate for discontinuation of rifampin. All other reactions were classified as inappropriate.
RESULTS: Of 3520 patients, rifampin was discontinued in 68 (1.9%); of these, 57% had rifampin discontinued unnecessarily. Treatment by an inexperienced provider (adjusted odds ratio [ORadj] 4.0; 95% confidence interval [CI] 1.9–8.5), race (ORadj 3.1; 95%CI 1.4–6.9), history of previous treatment (ORadj 4.8; 95%CI 1.9–12.5), and history of methadone drug treatment (ORadj 12.6; 95%CI 5.3–29.9) were all associated with inappropriate rifampin discontinuation.
CONCLUSION: True intolerance was rare, even among those patients infected with the human immunodeficiency virus. Most patients with minor reactions can successfully complete treatment with rifampin, particularly if managed by a physician experienced in the treatment of tuberculosis.
Document Type: Regular Paper
Affiliations: New York City Department of Health, Bureau of Tuberculosis Control, New York, New York, USA
Publication date: February 1, 2000
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