Rifabutin

Definition
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Indication
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Tuberculosis, infections by atypical mycobacteria (MAI), prophylaxis of MAI infection in HIV patients with < 200 CD4 cells/μl.

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Dermatology

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Limited indication
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Pregnancy, lactation, children < 14 years, severe liver and kidney failure.

Dosage and method of use
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Tuberculosis (combination therapy): 150 mg/day p.o., in case of immunosuppression 300 mg/day p.o.

MAI: 300 mg/day p.o. for up to 6 months after achieving negative cultures; in combination with clarithromycin, other macrolides or triazole antifungals 300 mg/day. In combination with indinavir: 150 mg/day p.o.

MAI prophylaxis: 300 mg/day p.o.

Reminder. Patients with soft contact lenses must be informed about the possibility of permanent discolouration of the lenses!

Undesirable effects
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Allergic reactions, skin discoloration and discoloration of body excretions after red-orange, headaches, sleep disorders, uveitis, chest pain, anemia, eosinophilia, leukopenia, neutropenia, thrombopenia, abdominal pain, myalgias.

Interactions
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See Table 1.

Contraindication
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Rifamycin hypersensitivity, acute hepatitis or cirrhosis of the liver, occlusive scterus, thrombocytopenia.

Preparations
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Mycobutin

Tables
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Major interactions of rifabutin

Quinidine	Quinidine effect ↓
Clarithromycin	Rifabutin toxicity (plasma levels around 80% ↑, possibly dose reduction).
Cotrimoxazole	Cotrimoxazole effect ↓
Coumarins	Coumarin effect ↓
Dapsone	Dapsone effect ↓
Didanosine	Palpitations, tachycardia
Fluconazole	Rifabutin levels around 80% ↑, possible dose adjustment.
Glucocorticoids	Glucocorticoid effect ↓
Cardiac glycosides	Cardiac glycoside effect ↓
Contraceptives, oral	contraceptive effect ↓
L-methadone	L-methadone effect ↓
Opioids	Opioid effect ↓
Phenytoin	Phenytoin effect ↓
Sulfonylureas	Sulfonylurea effect ↓