What's the big deal with Rifampicin?

Along with the other TB drugs the antibiotic known as Rifampicin has various attributes; it can induce

• hepatoxicity
• flu like symptoms
• rashes and hot flushes
• nausea, vomiting
• breathing problems

It is little wonder that those diagnosed with latent TB are reluctant to commence therapy, especially those who are familiar with the known side effects - health care workers

NEW YORK (Reuters Health) - Hospital and nursing-home employees who are infected with latent tuberculosis may often decline drug therapy to prevent the disease from becoming active, a new study suggests.

..Compared with other study patients, healthcare workers -- all employees of a hospital or nursing home -- were nearly five times as likely to decline treatment, according to findings published in the medical journal Chest.

It wasn't all doom and gloom

One factor that did boost treatment compliance overall, however, was shorter therapy.

Most study patients who accepted treatment were placed on nine months of isoniazid, but those given four months of rifampin were more likely to complete treatment -- about 65 percent did, versus roughly 45 percent of those on isoniazid.

Another (positive) attribute of Rifampicin is that treatment can be monitored with an IGRA

IGRAs may be useful in evaluating the therapeutic response to rifampicin prophylaxis in TB contacts

This could be of value to those about to undertake a procedure that involves the suppression of the immune system (such as transplant patients, rheumatoid arthritis sufferers or those with Crohn's disease or are undergoing chemotherapy) or those that are at increased health risk, such as dialysis patients or diabetics.

At present there is no real way to determine if the treatment for latent TB has been successful, particularly if the TB is of a different strain and/or has a drug resistance.

It's all well and good to develop and promote a theory, proving it is another matter

tuberculosis trials are lengthy and thus need an exceptional commitment of time and money.

However the end is nigh

An ongoing clinical trial is testing the effectiveness of a three-month course of isoniazid plus another drug, *rifapentine.

"I hope that new regimens of three months...or less will be shown to be effective and will replace the current regimens," Horsburgh said.

*Rifapentine is the synthetic version of Rifampicin and was FDA approved in 1998.