Rifampin

INTRODUCTION

Indications

Active tuberculosis (with other agents). Elimination of meningococcal carriers. Unlabeled Use: Prevention of disease caused by Haemophilus influenzae type B in close contacts.

Action

Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms. Therapeutic Effects: Bactericidal action against susceptible organisms. Spectrum: Broad spectrum notable for activity against Mycobacterium spp., Staphylococcus aureus, H. influenzae, Legionella pneumophila, Neisseria meningitidis.

Adverse Reactions/Side Effects

CNS: ataxia, confusion, drowsiness, fatigue, headache, weakness. EENT: red discoloration of tears. GI: abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting, drug-induced hepatitis, red discoloration of saliva. GU: red discoloration of urine. Hemat: hemolytic anemia, thrombocytopenia. MS: arthralgia, myalgia. Misc: red discoloration of all body fluids, flu-like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess ataxia or incoordination that might affect gait, balance, and other functional activities. Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma (See Appendix E).

• Monitor signs of thrombocytopenia (bruising, nose bleeds, and bleeding gums) or hemolytic anemia (unusual weakness and fatigue, dizziness, jaundice, abdominal pain). Report these signs to the physician.

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

• Monitor confusion, drowsiness, fatigue, or weakness. Notify physician if these symptoms become problematic.

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 tears, saliva, urine, and other body fluids. Instruct patient to notify physician if discoloration becomes troublesome.

• Advise patient about the likelihood of GI reactions (nausea, vomiting, diarrhea, flatulence, abdominal pain, heartburn). Instruct patient to report severe or prolonged GI problems, or signs of drug-induced hepatitis (loss of appetite, yellow skin or eyes, severe nausea and vomiting, fever, sore throat, malaise, weakness, facial edema).

• Instruct patient to report other troublesome side effects such as severe or prolonged headache or flulike symptoms.

Pharmacokinetics

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed; enters CSF. Crosses placenta; enters breast milk.

Metabolism and Excretion: Mostly metabolized by the liver; 60% eliminated in feces via biliary elimination.

Half-life: 3 hr.