High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre.
<h4>Background</h4>Recent evidence suggests that higher rifampicin doses may improve tuberculosis (TB) treatment outcome.<h4>Methods</h4>In this observational cohort study we evaluated all TB patients who were treated with high-dose rifampicin (> 10 mg/kg daily) in our ref...
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doaj-4a92424a3d694ceb80c8f3ea5bededff2021-03-04T10:34:55ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01143e021371810.1371/journal.pone.0213718High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre.Charlotte SeijgerWouter HoefslootInge Bergsma-de GuchteneireLindsey Te BrakeJakko van IngenSaskia KuipersReinout van CrevelRob AarnoutseMartin BoereeCecile Magis-Escurra<h4>Background</h4>Recent evidence suggests that higher rifampicin doses may improve tuberculosis (TB) treatment outcome.<h4>Methods</h4>In this observational cohort study we evaluated all TB patients who were treated with high-dose rifampicin (> 10 mg/kg daily) in our reference centre, from January 2008 to May 2018. Indications, achieved plasma rifampicin exposures, safety and tolerability were evaluated.<h4>Results</h4>Eighty-eight patients were included. The main indications were low plasma concentrations (64.7%) and severe illness (29.5%), including central nervous system TB. Adjusted rifampicin dosages ranged from 900 mg to a maximum of 2400 mg (corresponding to 32 mg/kg) per day. Patients with severe illness received high-dose rifampicin immediately, the others had a higher dosage guided by therapeutic drug monitoring. Four patients developed hepatotoxicity, of which two were proven due to isoniazid. Re-introduction of high-dose rifampicin was successful in all four. Eighty-seven patients tolerated high-dose rifampicin well throughout treatment. Only one patient required a dose reduction due to gastro-intestinal disturbance.<h4>Conclusion</h4>High-dose rifampicin, used in specific groups of patients in our clinical setting, is safe and well-tolerated for the whole treatment duration. Measurement of drug exposures could be used as a tool/guide to increase rifampicin dosage if a reduced medication absorption or a poor treatment outcome is suspected. We suggest to administer high-dose rifampicin to patients with severe manifestations of TB or low rifampicin exposure to improve treatment outcome.https://doi.org/10.1371/journal.pone.0213718 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Charlotte Seijger Wouter Hoefsloot Inge Bergsma-de Guchteneire Lindsey Te Brake Jakko van Ingen Saskia Kuipers Reinout van Crevel Rob Aarnoutse Martin Boeree Cecile Magis-Escurra |
spellingShingle |
Charlotte Seijger Wouter Hoefsloot Inge Bergsma-de Guchteneire Lindsey Te Brake Jakko van Ingen Saskia Kuipers Reinout van Crevel Rob Aarnoutse Martin Boeree Cecile Magis-Escurra High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre. PLoS ONE |
author_facet |
Charlotte Seijger Wouter Hoefsloot Inge Bergsma-de Guchteneire Lindsey Te Brake Jakko van Ingen Saskia Kuipers Reinout van Crevel Rob Aarnoutse Martin Boeree Cecile Magis-Escurra |
author_sort |
Charlotte Seijger |
title |
High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre. |
title_short |
High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre. |
title_full |
High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre. |
title_fullStr |
High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre. |
title_full_unstemmed |
High-dose rifampicin in tuberculosis: Experiences from a Dutch tuberculosis centre. |
title_sort |
high-dose rifampicin in tuberculosis: experiences from a dutch tuberculosis centre. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2019-01-01 |
description |
<h4>Background</h4>Recent evidence suggests that higher rifampicin doses may improve tuberculosis (TB) treatment outcome.<h4>Methods</h4>In this observational cohort study we evaluated all TB patients who were treated with high-dose rifampicin (> 10 mg/kg daily) in our reference centre, from January 2008 to May 2018. Indications, achieved plasma rifampicin exposures, safety and tolerability were evaluated.<h4>Results</h4>Eighty-eight patients were included. The main indications were low plasma concentrations (64.7%) and severe illness (29.5%), including central nervous system TB. Adjusted rifampicin dosages ranged from 900 mg to a maximum of 2400 mg (corresponding to 32 mg/kg) per day. Patients with severe illness received high-dose rifampicin immediately, the others had a higher dosage guided by therapeutic drug monitoring. Four patients developed hepatotoxicity, of which two were proven due to isoniazid. Re-introduction of high-dose rifampicin was successful in all four. Eighty-seven patients tolerated high-dose rifampicin well throughout treatment. Only one patient required a dose reduction due to gastro-intestinal disturbance.<h4>Conclusion</h4>High-dose rifampicin, used in specific groups of patients in our clinical setting, is safe and well-tolerated for the whole treatment duration. Measurement of drug exposures could be used as a tool/guide to increase rifampicin dosage if a reduced medication absorption or a poor treatment outcome is suspected. We suggest to administer high-dose rifampicin to patients with severe manifestations of TB or low rifampicin exposure to improve treatment outcome. |
url |
https://doi.org/10.1371/journal.pone.0213718 |
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