Experience with rifabutin replacing rifampin in the treatment of tuberculosis.
METHODS
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 tolerated 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.
Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington 98104, USA. dhorne@u.washington.edu
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D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D017828:Rifabutin / Q000009:adverse effects / Q000627:therapeutic use*; D012293:Rifampin / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D014861:Washington
D000904:Antibiotics, Antitubercular; D017828:Rifabutin; D012293:Rifampin