Rifampin intolerance seen in 23% of patients with orthopedic infections
NEW YORK — Among 75 patients who began rifampin therapy in conjunction with other medications to treat staphylococcal prosthetic joint infection, 23% were rifampin intolerant, a presenter at the Musculoskeletal Infection Society Annual Open Scientific Meeting said.
In the retrospective study of patients in Hospital for Special Surgery’s prosthetic joint infection (PJI) database from 2008 to 2016, all patients who received rifampin had their implants retained. Andy O. Miller, MD, and his colleagues compared results among the rifampin-tolerant (RT) and rifampin-intolerant (RI) subgroups to assess the tolerability and safety of the drug, which he said has been associated with drug interactions, hepatoxicity and organ toxicity.
“Few contraindications to starting rifampin precluded its use. It is complicated to figure out what you are going to do with the other medicines. Discontinuation due to tolerance or allergy or toxicity happened a lot,” Miller said, summing up the study results.
The mean duration the rifampin was taken among the patients studied was 3 months in the RT group and 0.75 months in the RI group.
“There was no predictor in terms of the demographics that we could find of who would tolerate it. That was interesting because it has been reported that older women tolerate it less well, but we did not find that,” Miller said.
“Research into the anti-staph[ylococcal] efficacy and safety of some of these other rifamycins on the market or not yet on the market that have fewer drug interactions and less drug toxicity is certainly warranted,” he said. – by Susan M. Rapp
Miller AO, et al. Safety and tolerability of rifampin in staphylococcal orthopedic infections. Presented at: Musculoskeletal Infection Society Annual Open Scientific Meeting; Aug. 2-3, 2019; New York.
Disclosure: Miller reports no relevant financial disclosures.