A review of the published literature has allowed the identification of a number of non-tubercular indications where rifampicin (trade mark Ciba-Geigy: Rimactane^>) has been successfully used in combination with other chemotherapeutic agents. The cases reviewed with regard to effectiveness sum 562. The most frequently combined drugs were aminoglycosides (mainly gentamicin), cotrimoxazole, colistine, vancomycin and fusidic acid, these two latter in cases due to Staphylococcus spp. The main indications where combined rifampicin treatment led to favourable results were UTI (success rate 64.9%), bone infections (86.9%), staphylococcal endocarditis (85.0%), respiratory tract infections often due to gram-negative rods (97.7%) as well as skin and soft tissue infections (83.3%), and bacterial meningitis (100%). Very favourable results were obtained in a non-life-threatening though epidemiologically important condition, i.e. salmonella carriers, where a 100% conversion rate was reached in an average period of 6 weeks. Special attention may deserve the combined treatment of fungal infections with rifampicin and amphotericin B. Tolerability was evaluated on a total of 650 cases. It appears to be good for daily doses up to 1,200 mg/day, even on long-term treatment; less so for the highest doses used (1,800 or 30 mg/kg a day). The clinical results, which are in good agreement with the results of the in vitro tests, indicate that rifampicin may have an important role in the combined treatment of severe non-mycobacterial infections. Further prospective, whenever possible, comparative studies are warranted for a thorough appraisal of its possible usefulness.

Patients with normal liver function present a dose-related change in the kinetics of rifampicin. The drug interferes with serum bilirubin levels. Interference with serum bilirubin levels practically disappears during repeated administration. This fact is paralleled by a change in the slope of the excretory part of rifampicin blood serum level curve. Patients with liver cirrhosis or with other type of severe liver impairment present higher blood serum levels of the antibiotic. The slope of the curve is flat and remains practically constant during repeated administration. The interference with blood serum bilirubin remains unchanged throughout the treatment period. In such patients, a dose of 6–8 mg/kg b.w. of rifampicin should not be exceeded.

Dose-related changes of the overall elimination rate constant were observed both after single and repeated administration of rifampicin. The threshold dose appears to be between 12 and 16 mg/kg in patients with normal liver function. Interference between rifampicin and bilirubin is confirmed. It does not appear dose-related and decreases during repeated administration.

A review of the published literature has allowed the identification of a number of non-tubercular indications where rifampicin (trade mark Ciba-Geigy: Rimactane^>) has been successfully used in combination with other chemotherapeutic agents. The cases reviewed with regard to effectiveness sum 562. The most frequently combined drugs were aminoglycosides (mainly gentamicin), cotrimoxazole, colistine, vancomycin and fusidic acid, these two latter in cases due to Staphylococcus spp. The main indications where combined rifampicin treatment led to favourable results were UTI (success rate 64.9%), bone infections (86.9%), staphylococcal endocarditis (85.0%), respiratory tract infections often due to gram-negative rods (97.7%) as well as skin and soft tissue infections (83.3%), and bacterial meningitis (100%). Very favourable results were obtained in a non-life-threatening though epidemiologically important condition, i.e. salmonella carriers, where a 100% conversion rate was reached in an average period of 6 weeks. Special attention may deserve the combined treatment of fungal infections with rifampicin and amphotericin B. Tolerability was evaluated on a total of 650 cases. It appears to be good for daily doses up to 1,200 mg/day, even on long-term treatment; less so for the highest doses used (1,800 or 30 mg/kg a day). The clinical results, which are in good agreement with the results of the in vitro tests, indicate that rifampicin may have an important role in the combined treatment of severe non-mycobacterial infections. Further prospective, whenever possible, comparative studies are warranted for a thorough appraisal of its possible usefulness.

A parenteral formulation of rifampicin (Rimactan® i.v., Ciba-Geigy, Basel, Switzerland) was administered to 237 critically ill or comatose patients, or patients with gastro-intestinal or absorption problems. There were 160 patients suffering from tuberculosis, 77 suffering from non-tuberculous (non-tb) infections including 30 cases of sepsis, 8 cases of bacterial meningitis and/or cerebral abscess and 9 patients with Legionnaires’ disease. The usual daily dose of rifampicin was 450–600 mg, administered in most cases by i.v. bolus (122 cases) or i.v. drip infusion (79 cases) for a period of 1–113 days. Rifampicin was in all cases combined with one or more antimicrobial drug(s). The physicians considered the therapy as successful when the treatment with oral rifampicin could be instituted soon after parenteral administration or when the patients markedly improved their clinical condition. Of a total of 123 tuberculous patients for whom assessment of efficacy was possible, 100 (81.3%) showed favourable clinical results. Of 40 non-tb patients who could be analysed for clinical progress, 32 (80.0%) had a favourable outcome. Special attention should be drawn to the 11 patients with proven staphylococcal infections, of whom 10 were cured clinically and/or bacteriologically. Thrombophlebitis occurred in 10 out of the 237 (4.2%) patients, almost always in patients who were treated for more than 30 days. Systemic unwanted effects occurred in 14 (5.9%); the relationship to the treatment was not always established. Treatment was withdrawn due to unwanted effects in 5 (2.1%) of the 237 patients. Taking into account the severe, life-threatening infections reported, the results suggest that i.v. rifampicin is useful and in some critically ill patients even life-saving. Tolerability was good, even in long-term i.v. administration, although there seems to be the possibility that thrombophlebitis might develop if treatment is continued over 30 days.