Duration of rifampin chemoprophylaxis for contacts of patients infected with Haemophilus influenzae type B

Abstract

Rifampin is recommended as a prophylactic treatment for intimate contacts of young children who develop invasive infections with Haemophilus influenzae type B (Hib). A 4-day course of rifampin (20 mg/kg of body weight per day, not to exceed 600 mg as a maximum single daily dose) is 95% effective in eradicating pharyngeal colonization with Hib, thus effectively reducing the risk of both associated patients and recurrent illness in index patients less than 2 years old. This study compares rates of eradication of pharyngeal colonization with Hib for 2-and 4-day courses of rifampin therapy. One hundred sixty-three patients with Hib infection were treated at Children's Hospital of Pittsburgh between January 1986 and December 1988; prophylaxis was recommended for 128. Participating families were randomized to receive either 2-or 4-day therapy. Throat swabs were obtained from contacts prior to therapy. Repeat cultures were obtained from colonized contacts 2 days after completing rifampin and again on all contacts 7 to 10 days after completing therapy. Of 68 participating families, 34 received 2-day and 34 received 4-day therapy with rifampin. Twenty-two of 24 colonized contacts in the 2-day group and 17 of 18 in the 4-day group had negative cultures for Hib on follow-up. Two-day therapy with rifampin appears to be as effective as 4-day treatment in the eradication of Hib pharyngeal colonization.

Investigation of Rifampicin Resistance Mechanisms in Brucella abortus Using MS-Driven Comparative Proteomics

“…Depending on its concentration, this antibiotic can have bacteriostatic or bactericidal effects. 34 Rifampicin can have bactericidal activity against slow and irregularly growing Mycobacterium tuberculosis organisms and it also plays a significant role in the treatment of methicillinresistant Staphylococcus aureus (MRSA), 35 Neisseria meningitidis, 36 N. gonorrheae, 37 Haemophilus inf luenza, 38 Listeria species, 39 Legionella pneumophila, 40 and Brucella species. 1 Mutations on the rpoB gene often occur under rifampicin stress.…”

Recommendations for the prevention of secondary Haemophilus influenzae type b (Hib) disease

“…32,35e38,63e66 A lower dose of rifampicin at 10 mg/kg/ day for four days 37 or a shorter two-day course of 10 mg/ kg/day either daily 67 or twice daily 29 were less effective, possibly because of a lower peak antibiotic levels. 68 However, one prospective randomised controlled trial comparing a four-day course of rifampicin (20 mg/kg a day up to a maximum of 600 mg) with a two-day course at the same Table 3 Secondary attack rate among US household contacts within 30 days of hospitalisation of the index case. It was possible to combine studies on secondary attack rates in households because the chi-squared test for heterogeneity showed that the attack rates were not significantly different (p Z 0.4 for any Hib disease, p Z 1.0 for both the <2-year-old and <4/<5-year-old age groups; for Hib meningitis, p Z 0.6 for <2-year-old, p Z 0.9 for the <4/<5-year-old and p Z 0.10 for the >4-year-old age group).…”

Infections of the Upper and Middle Airways

“…32,[35][36][37][38][63][64][65][66] A lower dose of rifampicin at 10mg/kg/day for four days 37 or a shorter two-day course of 10mg/kg/day either daily 67 or twice daily 29 were less effective, possibly because of a lower peak antibiotic levels. 68 However, one prospective randomised controlled trial comparing a four-day course of rifampicin (20 mg/kg a day up to a maximum of 600 mg) with a two-day course at the same dose reported similar rates of clearance of Hib pharyngeal colonisation (94% vs. 92%) among family contacts, with identical 95% confidence intervals (73-99%), although this study was poorly powered, with only 18 and 24 participants in the two groups, respectively. Other antibiotics including cotrimoxazole, ampicillin, cefaclor and a single dose of ceftriaxone were less effective than rifampicin.…”