Rates and risk factors for discontinuation of rifampicin.
METHODS
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 > or =60 days of treatment.


OBJECTIVE
To identify rates of and reasons for rifampin discontinuation.


METHODS
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 3,520 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.


CONCLUSIONS
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.
Cook
S V
SV
New York City Department of Health, Bureau of Tuberculosis Control, New York 10013, USA.
Fujiwara
P I
PI
Frieden
T R
TR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage* / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D016001:Confidence Intervals; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage* / Q000009:adverse effects*; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome / Q000209:etiology / Q000517:prevention & control*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology; D044465:White People
D000904:Antibiotics, Antitubercular; D012293:Rifampin