Rifampicin bone infections

Gentamicin and vancomicyn are the antibiotics most widely typically used for the treatment of bone infections. Sometimes a combination of antibiotics used, for instance, rifampicin together with clindamycin or with gentamicin, showed a broader range of action when compared with monotherapy. As an alternative, these combinations can be advantageous, avoiding the likelihood of resistance development [72,73]. 

So far only four cases of an interaction between rifampicin and chloramphenicol appear to have been reported. However, the evidence is of good quality and in line with the way rifampicin interacts with other drugs, so this interaction should be taken seriously. There is a risk that serum chloramphenicol levels will become subtherapeutic. The authors of the second report point out that raising the chloramphenicol dosage may possibly expose the patient to a greater risk of bone marrow aplasia. They suggest delaying rifampicin prophylaxis in patients with invasive Haemophilus influenzae infections until the end of chloramphenicol treatment. 

Legout L, Valette M, Dezeque H, Nguyen S, Lemaire X, Loiez C, Caillaux M, Beltrand E, Dubreuil L, Yazdanpanah Y, Migaud H, Senneville E. Tolerability of prolonged linezolid therapy in bone and joint infection protective effect of rifampicin on the occurrence of anaemia J Antimicrob Chemother 2010 65(10) 2224-30. 

Comparative studies In a prospective comparison of a combination of rifampicin and linezolid with a combination of rifampicin and co-trimoxazole in the treatment of bone and joint infections in 56 adults, 36 had infected orthopedic devices and 20 had chronic osteomyelitis [80. Patients who discontinued antibiotic therapy within 4 weeks of starting treatment were considered to be cases of treatment failure and were excluded. The rates of adverse effects were similar in the two groups 43% versus 46% respectively, and led to... 

Nguyen S, Pasquet A, Legout L, Beltrand E, Dubreuil L, Migaud H, Yazdanpanah Y, Senneville E. Efficacy and tolerance of rifampicin-linezolid compared with rifampicin-cotrimoxazole combinations in prolonged oral therapy for bone and joint infections. Clin Microbiol Infect 2009 15(12) 1163-9. 

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