Activity of rifampin plus trimethoprim againstHaemophilus influenzae

Rimactan parenteral formulation in clinical use

One hundred and forty-nine mainly critically ill or comatose patients or patients with problems of gastro-intestinal tolerability and/or absorption have been treated during the last few years with a parenteral formulation of rifampicin made available for release in special cases, on humanitarian grounds.

The cases reported include ninety-seven tuberculous patients (eighteen of whom were suffering from tubercular meningitis) and fifty-two patients suffering from non-tuberculous infections, including twenty-two cases of sepsis (fifteen due to staphylococci), four cases of bacterial meningitis and four cases of Legionnaires' disease.

R ifampicin was administered in each case, together with at least one other suitable antibacterial agent, mainly by intravenous bolus injection (seventy-four cases) or intravenous drip infusion (forty-four cases), at daily doses ranging from 150 to 1800 mg. The duration of treatment ranged from 1 to 113 days.

Data allowing an assessment of effectiveness were made available for sixty-eight tuberculous patients, sixty-three of which (92.6%) showed favourable results, and for twenty-seven patients with non-tuberculous infections, nineteen of which (70.4%) had a favourable outcome. Especially favourable were the results in the cases of staphylococcal sepsis (78.6% of clinical and/or bacteriological cures).

Tolerability was good in most cases. Only fourteen of the 149 patients showed signs of local intolerability (thrombo-phlebitis), almost always occurring in patients treated for over 60 days. Fifteen patients (10%) complained of systemic unwanted effects, the relationship of which to the treatment was not always established. Treatment was finally withdrawn because of tolerability problems in only three of the 149 cases (2%).

Bearing in mind the very varied nature of the severe, life-threatening infections reported here, two comments may be made:

Intravenous rifampicin is useful and even life-saving in both severe tuberculous and non-tuberculous infections. It is safe even in long-term administration. However, treatments lasting over 30–60 days appear to involve a higher risk of venous thrombo-phlebitis.