Effect of Rifampicin on the Pharmacokinetics of Fluconazole in Patients with AIDS

Ayudhya, Duangchit Panomvana Na; Thanompuangseree, Nawarat; Tansuphaswadikul, Somsit

doi:10.2165/00003088-200443110-00003

Cited by 53 publications

(33 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Table 2 shows a list of the drug interactions that may significantl reduce serum concentration of antifungal drugs, as well as the recommended actions for each situation. Most of the drug-drug interactions occur with the azoles [59,[64][65][66][67], and interactions that may compromise the treatment of the IFI rarely involve the other classes of antifungal drugs, with the exception of caspofungin [68].…”

Section: Differential Diagnosis Of Treatment Failurementioning

confidence: 99%

When Primary Antifungal Therapy Fails

Nucci

Perfect

2008

CLIN INFECT DIS

View full text Add to dashboard Cite

The prognosis for persons with invasive fungal infections has improved over the past 2 decades because of the development of new diagnostic tools, a better understanding of the epidemiology and prognostic factors of these infections, and the availability of new antifungal agents. Nevertheless, antifungal therapy failure is still a substantial clinical problem. When this occurs, the clinician is tempted to attribute therapeutic failure to specific drug resistance and then to change therapy or add another antifungal drug to the regimen. However, other factors may play an even greater role in antifungal therapy failure, such as host factors, low concentration of the drug at the site of infection, drug toxicities, wrong diagnosis, and misdiagnosis of failure because of the occurrence of immune reconstitution inflammatory syndrome. In this review, we discuss the differential diagnosis and management of antifungal therapy failure in invasive mycoses, to help clinicians appreciate the meaning of primary antifungal therapy failure.

show abstract

Section: Differential Diagnosis Of Treatment Failurementioning

confidence: 99%

When Primary Antifungal Therapy Fails

Nucci

Perfect

2008

CLIN INFECT DIS

View full text Add to dashboard Cite

show abstract

“…Several existing case reports have evaluated the effect of rifampin on the pharmacokinetics of antifungal agents, such as fluconazole (25), itraconazole (19)(20)(21)(22), voriconazole (26), and posaconazole (27). However, data concerning the drug interactions between rifabutin and antifungal azoles are very limited.…”

mentioning

confidence: 99%

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Moon

Park

Jeong

et al. 2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

bWe investigated the effects of rifampin and rifabutin on serum itraconazole levels in patients with chronic pulmonary aspergillosis. Serum itraconazole concentrations were significantly lower in patients who received itraconazole with rifampin (median, 0.1 g/ml; P < 0.001) or rifabutin (median, 0.34 g/ml; P < 0.001) than those receiving itraconazole alone (median, 5.92 g/ml). Concomitant use of rifampin or rifabutin and itraconazole should be avoided in patients with chronic pulmonary aspergillosis and coexisting mycobacterial infections. Chronic pulmonary aspergillosis (CPA) is a slowly progressive pulmonary infectious disease secondary to local invasion by a species of Aspergillus, usually Aspergillus fumigatus (1, 2). Although the optimal therapeutic regimen and duration of treatment have not been established, long-term oral itraconazole is currently recommended as the primary treatment for CPA (3-5). CPA usually occurs in middle-aged and elderly patients, for whom the most common underlying disease is pulmonary tuberculosis (6, 7). In addition, there is increasing evidence that nontuberculous mycobacterial (NTM) lung disease is an important underlying condition associated with CPA (7-12), with some patients having CPA and coexisting NTM lung disease (12,13).Mycobacterium avium complex (MAC) is the most common etiology of NTM lung disease (14-16). Rifampin is recommended as part of a multidrug antibiotic regimen for the treatment of MAC lung disease (14-16). Rifampin is a potent inducer of hepatic cytochrome P450 enzymes, which in turn can accelerate the hepatic metabolism of antifungal agents. In this way, rifampin presents a practical challenge for choosing the appropriate antibiotics for treating CPA with coexisting NTM lung disease (17,18). Indeed, previous case reports have demonstrated that concurrent administration of rifampin with itraconazole can greatly reduce serum itraconazole concentrations (19)(20)(21)(22).Rifabutin has less severe drug-drug interactions than does rifampin and is used as a substitute for rifampin in the treatment of tuberculosis and NTM lung disease, especially for patients who are receiving medications that have unacceptable interactions with rifampin, such as antiretroviral agents (14, 23). Nevertheless, there are no published studies that evaluated the interaction between rifabutin and itraconazole. Thus, the objective of the present study was to investigate the effects of rifampin and rifabutin on serum itraconazole levels in patients with CPA and coexisting mycobacterial lung disease.This study was a single-institution retrospective review of 66 patients with CPA who were treated with oral itraconazole (Sporanox, Janssen Pharmaceutica) (200 mg twice daily) and for whom serum itraconazole concentrations were measured between January 2013 and June 2014. Peripheral venous sampling was performed prior to morning itraconazole administration to determine trough concentrations after at least 7 days of treatment.The serum concentrations of itraconazole and hydroxyl-itraconazole we...

show abstract

“…In a majority of the treatment cases, miconazole was initially used before giving way to fluconazole use in more recent cases. 14␣-Demethylase is a CYP450 isoform, and obvious interactions between rifampin and fluconazole have been reported (38,39). Coadministration of the two drugs leads to significant changes in the pharmacokinetics of fluconazole: a Ͼ20% decrease in area under the concentrationtime curve (AUC) and as much as a 50% decrease in critically ill patients, at least a 30% increase in clearance rate, and a 28% shorter half-life.…”

Section: Adjunctive Therapiesmentioning

confidence: 99%

Naegleria fowleri: Pathogenesis, Diagnosis, and Treatment Options

Grace

Asbill

Virga

2015

Antimicrob Agents Chemother

195

187

View full text Add to dashboard Cite

Naegleria fowleri has generated tremendous media attention over the last 5 years due to several high-profile cases. Several of these cases were followed very closely by the general public. N. fowleri is a eukaryotic, free-living amoeba belonging to the phylum Percolozoa. Naegleria amoebae are ubiquitous in the environment, being found in soil and bodies of freshwater, and feed on bacteria found in those locations. While N. fowleri infection appears to be quite rare compared to other diseases, the clinical manifestations of primary amoebic meningoencephalitis are devastating and nearly always fatal. Due to the rarity of N. fowleri infections in humans, there are no clinical trials to date that assess the efficacy of one treatment regimen over another. Most of the information regarding medication efficacy is based on either case reports or in vitro studies. This review will discuss the pathogenesis, diagnosis, pharmacotherapy, and prevention of N. fowleri infections in humans, including a brief review of all survivor cases in North America. N aegleria fowleri has generated tremendous media attention over the last 5 years due to several high-profile cases. Several of these cases were followed very closely by the national news outlets, as well as the general public. Unfortunately, much of the media attention served to generate public fear rather than public education. In this review, we will discuss the etiology, pathogenesis, case studies, and treatment options for N. fowleri.

show abstract

Effect of Rifampicin on the Pharmacokinetics of Fluconazole in Patients with AIDS

Abstract: Coadministration of rifampicin with fluconazole caused significant changes in the pharmacokinetic parameters of fluconazole. Long-term monitoring for recurrence rates of cryptococcal meningitis is required to assess the clinical significance of this interaction.

Cited by 53 publications

References 14 publications

When Primary Antifungal Therapy Fails

When Primary Antifungal Therapy Fails

Effect of Rifampin and Rifabutin on Serum Itraconazole Levels in Patients with Chronic Pulmonary Aspergillosis and Coexisting Nontuberculous Mycobacterial Infection

Naegleria fowleri: Pathogenesis, Diagnosis, and Treatment Options

Contact Info

Product

Resources

About