Rifabutin

INTRODUCTION

Indications

Prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection. Unlabeled Use: Treatment of Helicobacter pylori ulcer disease which has failed on other regimens (with pantoprazole and amoxicillin).

Action

Appears to inhibit DNA-dependent RNA polymerase in susceptible organisms. Therapeutic Effects: Antimycobacterial action against susceptible organisms. Spectrum: Active against M. avium and most strains of M. tuberculosis.

Adverse Reactions/Side Effects

EENT: brown-orange discoloration of tears, ocular disturbances. Resp: dyspnea. CV: chest pain, chest pressure. GI: PSEUDOMEMBRANOUS COLITIS, brown-orange discoloration of saliva, altered taste, drug-induced hepatitis. GU: brown-orange discoloration of urine. Derm: rash, skin discoloration. Hemat: hemolysis, neutropenia, thrombocytopenia. MS: arthralgia, myositis. Misc: brown-orange discoloration of body fluids, flu-like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Assess any joint pain or muscle pain and inflammation to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor any chest pain, chest pressure, or difficult, labored breathing. Attempt to determine if pain is drug induced or caused by cardiovascular dysfunction (e.g., angina that occurs during exercise).

• Monitor signs of neutropenia (fever, sore throat, signs of infection) or thrombocytopenia (bruising, nose bleeds, and bleeding gums). Report these signs to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient about possible discoloration of skin, tears, saliva, and other body fluids. Instruct patient to notify physician if discoloration becomes troublesome or if skin rashes or other skin reactions become problematic.

• Instruct patient to report signs of drug-induced hepatitis, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising.

• Instruct patient to report other troublesome side effects such as vision problems, altered taste, or flulike symptoms.

Pharmacokinetics

Absorption: Well absorbed following oral administration (50–85%). Absorption is decreased in HIV-positive patients (20%).

Distribution: Widely distributed to body tissues and fluids.

Metabolism and Excretion: Mostly metabolized by the liver; <5% excreted unchanged by the kidneys.

Half-life: 45 hr.