Experience with rifabutin replacing rifampin in the treatment of tuberculosis
SETTING: The use of a rifamycin in anti-tuberculosis treatment regimens is crucial for shortening treatment and achieving favorable outcomes. Rifampin (RMP) is the recommended rifamycin, although adverse effects (AEs) may require its discontinuation. The use of rifabutin (RFB), a rifamycin
with activity against Mycobacterium tuberculosis, in patients with an RMP-related AE has not been well studied. OBJECTIVE: To review our experience with RFB in tuberculosis (TB) treatment. METHODS: We included TB patients who received RFB in their treatment regimens from 2003 to 2009.
We evaluated the indications for RFB and, if applicable, the likelihood that RMP caused an AE. We identified RMPrelated AEs associated with RFB intolerance. RESULTS: One hundred subjects were included. The indications for RFB use were RMP-related AE (57%), con- current antiretroviral therapy
(21%), potential/actual interaction with other medications (14%), and as part of an alternative regimen in liver disease (8%). Nineteen patients experienced an AE while taking RFB. Among patients with a prior RMP-related AE, 80% of whom were successfully treated with RFB, only a dermatologic
AE was associated with subsequent RFB intolerance. CONCLUSIONS: Our study suggests that RFB is well tol- erated by patients who develop RMP-related AEs. There may be an increased risk for RFB-related AE in patients who experienced RMP-related dermatologic events.
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Document Type: Research Article
Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington, USA
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA; Tuberculosis Control Program, Public Health–Seattle & King County, Seattle, Washington, USA
Division of Pulmonary and Critical Care Medicine; Tuberculosis Control Program, Public Health–Seattle & King County, Seattle, Washington, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
Publication date: November 1, 2011
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