Treatment of tuberculosis with rifabutin in a renal transplant recipient.
Development of tuberculosis infection in a renal transplant patient is infrequent in Spain, although the prevalence is higher than in the general population. These patients usually receive calcineurin inhibitors as the main component of their immunosuppressive treatment. The metabolism of these drugs, whether cyclosporine or tacrolimus, involves cytochrome P-450 3A. Rifampin, a widely used agent in the treatment of tuberculosis, is also an important inducer of cytochrome P-450 3A metabolism and has the capacity to decrease serum levels of the calcineurin inhibitors. This metabolic interaction makes pharmacologic management of tuberculosis-infected transplant patients more complex and can result in a higher risk of acute rejection caused by decreased levels of the immunosuppressant in the blood. The authors present a case of a renal transplant patient with a soft tissue infection caused by Mycobacterium tuberculosis who was treated with rifabutin instead of rifampin, with excellent results in terms of graft survival and overall survival. The use of rifabutin allowed the authors to achieve better control of circulating immunosuppressant levels and a lower probability of acute graft rejection.
López-Montes
Aurora
A
Servicio de Nefrología, Hospital General Universitario de Albacete, Albacete, Spain. auroralmontes@hotmail.com
Gallego
Eduardo
E
López
Esperanza
E
Pérez
Juan
J
Lorenzo
Inmaculada
I
Llamas
Francisco
F
Serrano
Ana
A
Andrés
Elena
E
Illescas
Luisa
L
Gómez
Carmen
C
D000038:Abscess / Q000188:drug therapy*; D000328:Adult; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation; D017828:Rifabutin / Q000627:therapeutic use*; D018461:Soft Tissue Infections / Q000188:drug therapy*; D014376:Tuberculosis / Q000188:drug therapy*
D000904:Antibiotics, Antitubercular; D017828:Rifabutin