Rifampicin Ciprofloxacin

Cuevas LE, Kazembe P, Mughogho GK, Til-lotson GS, Hart CA Eradication of nasopharyngeal carriage of Neisseria meningitidis in children and adults in rural Africa A comparison of ciprofloxacin and rifampicin. J Infect Dis 1995 171 728-731. 

Theophylline is a narrow therapeutic index drug with significant difference in bioavailability following oral administration. The half-life of the drug is increased by heart failure, cirrhosis and viral infections, in elderly patients, and by certain drugs, such as cimetidine, ciprofloxacin, oral contraceptives and fluvoxamine. The half-life is decreased in smokers, chronic alcoholism, and by certain drugs, such as phenytoin, rifampicin and carbamazepine. 

Among the antimycobacterials often a differentiation is made between first-choice and second-choice agents. The first-choice agents include iso-niazid, rifampicin, ethambutol, pyrazinamide and streptomycin or as alternatives the other aminoglycosides amikacine or kanamycine. The second-choice agents include the quinolones ciprofloxacin and ofloxacin and also the rifamycin derivative rifabutin. 

To prevent secondary cases of meningococcal disease prophylaxis with rifampicin 600 mg orally twice daily for two days is recommended for close contacts with the index case. A single dose of 500 mg ciprofloxacin orally is also effective in eliminating nasopharyngeal carriage of N. meningitidis. 

Sustained-release formulations can produce stable serum concentrations with once or twice daily dosage. Therapeutic effects occur at blood levels > 5 mg/1, and side effects increase considerably at levels > 15 mg/1. Smoking, alcohol, anticonvulsants, and rifampicin induce the drug-metabolizing enzyme system in liver and reduce the half-life of theophylline. On the other hand, heart and liver failure, sustained fever, old age and drugs such as cimeti-dine, ciprofloxacin, and oral contraceptives reduce theophylline clearance and thereby increase serum concentrations. 

Of the other broad-spectrum antibiotics commonly used in hospitals, gentamicin does not penetrate the CNS to achieve therapeutically useful concentrations and ciprofloxacin is not reliable against S. pneumoniae. Of the car-bapenems, meropenem achieves better CNS penetration than imipenem. Vancomycin has poor CNS penetration but is prescribed routinely in countries with penicillin-resistant S. pneumoniae, often with rifampicin which achieves CSF concentrations effective against S. pneumoniae but not Neisseria meningitidis or Haemophilus influenzae. 

Rifampicin (600 mg orally twice daily for 2 days) should be administered to patients with meningococcal or H. influenzae meningitis who have not been treated with ceftriaxone, as soon as they can tolerate oral medication to eliminate nasal carriage of the organisms. Alternatively ciprofloxacin (500 mg orally stat) has proven efficacy for elimination of nasal carriage of meningococcus only. 

Spread of meningococcus between family members and close contacts is well recognised and chemoprophylaxis is recommended for close contacts as soon as possible, preferably within 24 hours. Rifampicin 600 mg every 12 hours for 2 days is licensed for chemoprophylaxis but ciprofloxacin 500 mg orally as a single dose (unlicensed) is also effective and often recommended for convenience. 

The drug interactions with rifampicin and ciprofloxacin would also need to be taken into account if hormonal methods were used [19, 36]. 

Rifampicin - for pruritns Ursodeoxycholic acid - to improve bile flow Ciprofloxacin - for recurrent cholangitis Vitamins A and D - fat-soluble vitamin supplements... 

Pharmacokinetic interaction the drugs interact remotely from the target site to alter plasma (and other tissue) concentrations so that the amount of the drug at the target site of clinical effect is altered, e.g. enzyme induction by rifampicin will reduce the plasma concentration of warfarin enzyme inhibition by ciprofloxacin will elevate the concentration of theophylline. 

Meningococcal meningitis often occurs in epidemics in closed communities, but also in isolated cases. Close personal contacts should receive oral rifampicin 600 mg 12-hourly for 2 days. Single doses of oral ciprofloxacin (500 mg) or i.m. ceftriaxone (2 g) are alternatives, the latter of particular value for pregnant women. 

It acts by inhibiting RNA synthesis, bacteria being sensitive to this effect at much lower concentrations than mammalian cells it is particularly effective against mycobacteria that lie semidormant within cells. Rifampicin has a wide range of antimicrobial activity. Other uses include leprosy, severe Legionnaires disease (with erythromycin or ciprofloxacin), the chemoprophylaxis of meningococcal meningitis, and severe staphylococcal infection (with flucloxacillin or vancomycin). 

Antimicrobials. Aztreonam, cefamandole, chloramphenicol, ciprofloxacin, co-trimoxazole, erythromycin, fluconazole, itraconazole, ketoconazole, metronidazole, miconazole, ofloxacin and sulphonamides (including co-trimoxazole) increase anticoagulant effect by mechanisms that include interference with warfarin or vitamin K metabolism. Rifampicin and griseofulvin accelerate warfarin metabolism (enzyme induction) and reduce its effect. Intensive broad-spectrum antimicrobials, e.g. eradication regimens for Helicobacter pylori (see p. 630), may increase sensitivity to warfarin by reducing the intestinal flora that produce vitamin K. 

Rifampicin-induced lupus-like syndrome is associated with combination therapy with ciprofloxacin, since rifampicin is metabolized by (among others) CYP3A4, which is inhibited by ciprofloxacin, and combined usage may lead to higher rifampicin blood concentrations (81). 

Wurtz RM, Abrams D, Becker S, Jacobson MA, Mass MM, Marks SH. Anaphylactoid drug reactions to ciprofloxacin and rifampicin in HIV-infected patients. Lancet I989 I(8644) 955-6. 

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. 

Antibiotics ciprofloxacin, methiciiiin, peniciiiin G, ampiciiiin, cephaiothin, oxacillin, rifampicin. 

Antibiotic resistance behaviour of 308 enterococci isolated from Bryndza cheese is shown in Fig. 5. All enterococcal isolates from Bryndza cheese were susceptible to ampicillin, streptomycin, gentamicin, vancomycin, and teicoplanin. For these same isolates, resistance rates to rifampicin, erythromycin, ciprofloxacin, and... 

Fig. 5 Antibiotic resistance behaviour of 308 enterococci isolated from Bryndza. Ampicillin (AMP), streptomycin (STR), gentamicin (GEN), vancomycin (VAN), teicoplanin (TEI), rifampicin (RIF), erythromycin (ERY), ciprofloxacin (CIP), and nitrofurantoin (NIT)...

Figures 6-8 illustrate antibiotic resistance patterns of E. faecium, E. faecalis, and E. durans isolates from Bryndza cheese. No one of the E. faecium, E. durans, and E. faecalis isolates were resistant to ampicillin, streptomycin, gentamicin, vancomycin, and teicoplanin. Thirty six percent of the E. faecium isolates and 22% of the E. faecalis isolates were resistant to erythromycin. E. faecium showed similar resistance to rifampicin (31%) as E. faecalis (29%). Both E. faecium and E. faecalis strains exhibited the same resistance to ciprofloxacin (2%). E. durans isolates showed very low level of resistance to rifampicin, erythromycin, ciprofloxacin, and nitrofurantoin (1 %). E. faecium, E. faecalis and E. durans were also found to be the predominant species recovered from naturally ripened European cheeses and...

Forty eight (30%) of the E. faecium isolates, two (3%) of the E. durans isolates, and six (12%) of the E. faecalis isolates exhibited multidrug resistance. Ten percent of E. faecium, 0% of E. durans, and 17% of E. faecalis strains showed simultaneous resistance to three drugs (rifampicin, erythromycin, and ciprofloxacin or nitrofurantoin). For all E. faecium, E. durans, and E. faecalis isolates, 55 (19%) multidrug resistant strains were resistant to rifampicin, 55 (19%) strains were resistant to erythromycin, nine (2%) strains were resistant to ciprofloxacin, and one (0.3%) strain was resistant to nitrofurantoin. The incidence of multiple resistance to five or more antimicrobials of enterococcal cheese isolates was confirmed by Teuber et al. (1999) and Franz et al. (2001). In this respect it may be stated that the enterococcal isolates from Bryndza cheese have simultaneous resistance to fewer antimicrobials compared to the above-mentioned cheese isolates. 

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. 

Antibiotics ciprofloxacin, methicillin, penicillin G, ampicillin, cephalothin, oxacillin, rifampicin. 

An improvement of medical devices based on bacterial polymers by the encapsulation of different drugs, opens up the wide prospects in applications for these new devices with pharmacological activity in medicine. PHB polymer was used as a drug delivery matrix for sustaining the release of various drugs such as dipyridamole [DP], indomethacin and antibiotics (rifampicin, metronidazole, ciprofloxacin, levofloxacin), anti-inflammatory drugs (flurbiprofen, dexamethasone, prednisolone), and antitumor drugs (paclitaxel) [132]. 

Venlafaxine. An 85-year-old man taking venlafaxine 150 mg daily was prescribed ciprofloxacin, rifampicin and linezolid 600 mg twice daily for a hip prosthesis infection. After 20 days he was found to be confused and disorientated, and 4 days later he was also drowsy, and suffering myoclonic jerks. Linezolid and venlafaxine were stopped and the symptoms resolved over 2 days. However, another case report describes a 7-year-old boy treated with venlafaxine and methylphenidate who was prescribed linezolid for osteomyelitis. He was given all three drugs (doses not stated) for several days without any alterations in vital signs or evidence of the serotonin syndrome. ... 

Orisakwe OE, Afonne OJ, Agbasi PU, Ofoefule SI. Urinary excretion of rifampicin in the presence of ciprofloxacin, i4w J TTier (2004) 11, 171-4. 

This appears to be an isolated case but it is consistent with the way rifampicin interacts with other drugs. Clozapine serum levels should be well monitored if rifampicin is added, being alert for the need to increase its dosage. An alternative (as in this case) is to use another antibacterial. However, note that there are reports of an interaction between clozapine and ciprofloxacin , (p.749). 

---