Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?

Abstract

Rifampin is a potent antibiotic against staphylococcal implant-associated infections. In the absence of implants, current data suggest against the use of rifampin combinations. In the past decades, abundant preclinical and clinical evidence has accumulated supporting its role in biofilm-related infections.In the present article, experimental data from animal models of foreign-body infections and clinical trials are reviewed. The risk for emergence of rifampin resistance and multiple drug interactions are emphasized. A recent randomized controlled trial (RCT) showing no beneficial effect of rifampin in patients with acute staphylococcal periprosthetic joint infection treated with prosthesis retention is critically reviewed and data interpreted. Given the existing strong evidence demonstrating the benefit of rifampin, the conduction of an adequately powered RCT with appropriate definitions and interventions would probably not comply with ethical standards.

Rifamycin antibiotics and the mechanisms of their failure

“…Aside from TB, rifampicin is used in the treatment of leprosy [31], pneumococcal meningitis [32], as well as Staphylococcus and Legionella infections [33,34]. In the case of staphylococcal prosthetic joint infections, the Infectious Diseases Society of America recommends inclusion of rifampicin as part of combination treatments [7,8]; however, results published recently from a randomized controlled trial has called into question its utility in those scenarios [35], which has sparked debate on the topic [36]. Rifabutin was identified in 1980 and approved for the treatment of infections caused by the Mycobacterium avium complex (MAC) [2,37].…”

Antibacterial and Anti-Inflammatory Coating Materials for Orthopedic Implants: A Review

“…One of the first-line antituberculosis drugs, rifampicin is mainly used in antituberculosis treatment, although has been extensively investigated for use against nonmycobacterial microorganisms such as Staphylococcus for at least 50 years [52]. However, the effect of rifampicin on nonmycobacterial infection is controversial [53]. In a study by Zimmerli et al [54], rifampicin was added to ciprofloxacin in a randomized controlled trial (RCT) to treat implant-related infection; 18 patients were allocated to ciprofloxacin-rifampin and 15 patients to ciprofloxacinplacebo.…”

Current Insights in the Evaluation and Treatment of Infected Total Knee Arthroplasty

“…67 In addition to oral antibiotics targeted against the causative organisms, there is also sufficiently strong evidence demonstrating that rifampin is a beneficial addition to the chronic suppression regimen due to its efficacy against biofilms, particularly staphylococcal biofilm infections. 68,69…”