Rifampicin Doxycycline

ANTIARRHYTHMICS - disopyramide, propafenone 2. ANTIBIOTICS-chloramphenicol, doxycycline, metronidazole, rifampicin, telithromycin 3. ANTICANCER AND IMMUNOMODULATING DRUGS - carmustine, cidosporin, corticosteroids, doxorubicin, etoposide, ima-tinib, lomustine, paditaxel, tacrolimus, tamoxifen, toremifene, vinca alkaloids 4. ANTICOAGULANTS - ORAL 5. ANTI-... 

Antibiotics. Long-term administration of antibiotics could lead to vitamin B6 deficiency, If symptoms of peripheral neuropathy develop (numbness and tingling of the extremities), administer vitamin B6. Sulfasalazine can decrease the absorption of folic acid, and trimethoprim can cause folate deficiency, hence the need to administer folic acid if there is evidence of deficiency. Rifampicin can cause disturbances in vitamin D metabolism and lead to osteomalacia. The absorption of tetracyclines can be reduced by calcium, magnesium, iron and zinc, while this antibiotic could also decrease the absorption of these minerals. This effect is probably least with minocycline and is not confirmed with doxycycline. Doses of minerals and antibiotic should be separated by at least 2 hours. The absorption of quinolones is reduced by cationic and anionic supplements. 

Prostatitis due to vancomycin-resistant enterococci has been reported in a 42-year-old liver transplant recipient (84). The organism. Enterococcus faecium, was resistant to vancomycin, ampicillin, ciprofloxacin, and doxycycline. Treatment with a combination of rifampicin and nitrofurantoin for 6 weeks resulted in a long-lasting cure. 

The use of oxacillin is not recommended because it can cause necrosis at the point of injection. Doxycycline in combination with ciprofloxacin has no expected synergistic action. It is recommended to replace doxycycline with amikacin or rifampicin or, in their absence, cefotaxim. 

Rifampicin may cause a marked reduction in doxycycline levels, which has led to treatment failures in some cases. 

Rifampicin 10 mg/kg daily caused a considerable reduetion in the serum levels of doxycycline 200 mg daily in 7 patients. The reduetion was very marked in 4 patients but not significant in the other 3 patients. The AUC of doxycycline was reduced by 54%, its elearanee was approximately doubled, and its half-life was reduced from about 14 hours to 9 hours. 

Five patients with brucellosis taking doxyeyeline 200 mg daily had a reduction in the doxycycline half-life from 14.52 to 7.99 hours when they took rifampicin 200 mg daily Another study of 20 patients treated for brucellosis found that the mean AUC of doxyeyeline was nearly 60% lower in the presence of rifampicin as opposed to streptomyein. There were no treatment failures in the patients taking doxycycline and streptomyein, but 2 treatment failures occurred in the 10 patients taking doxyeyeline and rifampicin. ... 

A meta-analysis of 6 studies involving 544 patients with brueellosis found a significantly higher numbers of relapses and lower numbers of initial cures if doxycycline was given with rifampicin rather than streptomycin. ... 

Not established, but it seems almost certain that the rifampicin (a known potent enzyme inducer) increases the metabolism of the doxycycline thereby reducing its levels. 

The interaction between doxycycline and rifampicin is established and of clinical importance. Monitor the effects of concurrent use and increase the doxycycline dosage as necessary. No clinically important adverse interaction appears to occur between doxycycline and streptomycin. 

Garraffo R, Dellamonica P, Fournier JP, Lapalus P, Bernard E, Beziau H, Chichmanian RM. Effet de la rifampicine sur la pharmacocinetique de la doxycycline. Pathol Biol (Paris) (1987) 35, 746-9. 

Bessard G, Stahl JP, Dubois F, Gaillat J, Micoud M. Modification de la pharmacocinetique de la doxycycline par T administration de rifampicine chez Thomme. Med Mai Infect ( 9S3) 13, 138-41. 

Blank H, Cullen SI, Cataland PM (1968) Photosensitivity studies with demethyl-chlortetra-cycline and doxycycline. Arch Dermatol 97 1-2 Bojs G, Moller H (1974) Eczematous contact allergy to oxytetracycline with cross-sensitivity to other tetracyclines. Berufsdermatosen 22 202-208 Boman G, Nilsson BS, Saerens EJ (1973) Protein binding of rifampicin. Scand J Respir Dis [Suppl] 84 40-44... 

Farmers, shepherds, veterinarians and slaughtermen are at risk in endemic areas. Human infection is related to handling contaminated animals or ingesting milk and cheese that is contaminated and unpasteurised. Occupational injuries are another mode of entry. The skin manifestations are nonspecific and range from a maculopapular eruption to petechiae, which occur in less than 5% of patients. A chronic ulcer may develop at the site of inoculation or injury. Systemic symptoms include chills, high fever, headache and extreme weakness. The treatment of choice is a combination of doxycycline (100 mg twice per day) and rifampicin (300 mg 3 times per day) for 6 weeks. 

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