Breakpoints #104 – Dosing Consult: Rifampin Part 1
Oct 4, 2024
In this discussion, experts Chuck Peloquin, a TB treatment guideline contributor from the University of Florida, and Gerry Davies, an infection pharmacology professor at the University of Liverpool, delve into the complexities of rifampin dosing. They debate whether higher doses improve outcomes and explore toxicity thresholds. The duo also discusses alternative rifamycins and management strategies for patients with complications. Tune in for insights on optimizing treatment through therapeutic drug monitoring, especially for those with concurrent infections.
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Rifampin Development and PK
- Rifampin was established at 600 mg due to minimal effective dose and production costs when first developed.
- It has concentration-dependent killing with a short half-life that shortens due to auto-induction separate from CYP450 induction.
High Rifampin Dosing Benefits & Limits
- Higher rifampin doses up to 50 mg/kg are tolerable and can increase efficacy, but very high doses risk hyperbilirubinemia.
- Dose variability and individual patient's pharmacokinetics are key in optimizing dosing and therapeutic drug monitoring (TDM) is crucial.
Start Rifampin at 1200 mg
- Start rifampin dosing at 1,200 mg to avoid low exposures that delay bacterial clearance.
- Avoid beginning treatment with very high doses like 1,800 mg especially in older patients who may tolerate it less well.