title: Adequacy of Rifampin Absorption after Jejunostomy Tube Administration.
abstract: It is not always possible to administer antituberculosis pharmacotherapy orally for reasons that may be a direct consequence of tuberculosis itself. To our knowledge, no published literature is available regarding antituberculosis drug absorption via feeding tube. We present the case of a patient with tuberculosis meningitis who required medication administration via percutaneous endoscopic jejunostomy (PEJ) tube. Blood samples were collected during the continuation phase of antituberculosis therapy, immediately before dose administration, and then at 1, 2, 4, and 6 hours after dose administration for quantification of serum rifampin concentrations. Assaying these concentrations by high-pressure liquid chromatography demonstrated a peak serum rifampin level (C(max)) of 18 μg/ml and total rifampin exposure (area under the curve from 0-6 hours [AUC(0-6)]) of 50.1 μg/ml. These are high compared with rifampin C(max) and AUC(0-6) values reported in patients after oral rifampin administration; C(max) tends to range between 4.0-10.5 μg/ml and AUC(0-6) 7.0-52.9 μg/ml after oral administration of 600 mg at steady state. Based on our patient's results, therefore, rifampin administered by PEJ tube appears to be well absorbed, with preservation of adequate C(max) and AUC values. It is worth noting that this was in the context of drug administration in the fasted state. In the absence of any published evidence of adequate absorption via jejunal feeding tube in the nonfasted state, it would seem prudent to ensure that patients are fasted when rifampin is administered via PEJ tube, just as patients are when oral rifampin is administered. This report represents the first documented evidence, to our knowledge, of adequate rifampin absorption when administered via PEJ tube and provides important reassurance for health care providers, patients, and families facing similar clinical scenarios.
authors.affiliation: The Wolfson Centre for Personalised Medicine, The University of Liverpool, Liverpool, UK.|Royal Liverpool and Broadgreen University Hospitals, NHS Trust, Liverpool, UK.
authors.forename: Katharine E
authors.initials: KE
authors.lastname: Stott
authors.affiliation: Royal Liverpool and Broadgreen University Hospitals, NHS Trust, Liverpool, UK.
authors.forename: Bhagteshwar
authors.initials: B
authors.lastname: Singh
authors.affiliation: Royal Liverpool and Broadgreen University Hospitals, NHS Trust, Liverpool, UK.
authors.forename: Mike B J
authors.initials: MB
authors.lastname: Beadsworth
authors.affiliation: Royal Liverpool and Broadgreen University Hospitals, NHS Trust, Liverpool, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Vaudrey
authors.affiliation: The Wolfson Centre for Personalised Medicine, The University of Liverpool, Liverpool, UK.
authors.forename: Saye H
authors.initials: SH
authors.lastname: Khoo
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: Geraint
authors.initials: G
authors.lastname: Davies
mesh_terms: D058956:Administration, Mucosal; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006801:Humans; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism; D007582:Jejunostomy / Q000009:adverse effects*; D007583:Jejunum / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012293:Rifampin / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use; D014390:Tuberculosis, Meningeal / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin
keywords: dysphagia; jejunal absorption; jejunal feeding; meningitis; pharmacokinetics; rifampicin; rifampin; tuberculosis