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Antimicrob Agents Chemother. 2017 Oct 24;61(11). pii: e01054-17. doi: 10.1128/AAC.01054-17. Print 2017 Nov.

Pharmacokinetics, Tolerability, and Bacteriological Response of Rifampin Administered at 600, 900, and 1,200 Milligrams Daily in Patients with Pulmonary Tuberculosis.

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Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands.
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Tumaini University, Moshi, Tanzania.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
Ifakara Health Institute, Bagamoyo, Tanzania.
Kibong'oto National Tuberculosis Hospital, Sanya Juu, Tanzania.
Radboud University Medical Center, Department of Lung Diseases, Nijmegen, the Netherlands.
Radboud University Medical Center, Department of Internal Medicine, Nijmegen, the Netherlands.
Radboud University Medical Center, Department of Medical Microbiology, Nijmegen, the Netherlands.
Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands
Medical Centre of the University of Munich (LMU), Division of Infectious Diseases and Tropical Medicine, Munich, Germany.
German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
School of Medicine, University of St. Andrews, North Haugh, St. Andrews, United Kingdom.
MRC Clinical Trials Unit at UCL, London, United Kingdom.


In a multiple-dose-ranging trial, we previously evaluated higher doses of rifampin in patients for 2 weeks. The objectives of the current study were to administer higher doses of rifampin for a longer period to compare the pharmacokinetics, safety/tolerability, and bacteriological activity of such regimens. In a double-blind, randomized, placebo-controlled, phase II clinical trial, 150 Tanzanian patients with tuberculosis (TB) were randomized to receive either 600 mg (approximately 10 mg/kg of body weight), 900 mg, or 1,200 mg rifampin combined with standard doses of isoniazid, pyrazinamide, and ethambutol administered daily for 2 months. Intensive pharmacokinetic sampling occurred in 63 patients after 6 weeks of treatment, and safety/tolerability was assessed. The bacteriological response was assessed by culture conversion in liquid and solid media. Geometric mean total exposures (area under the concentration-versus-time curve up to 24 h after the dose) were 24.6, 50.8, and 76.1 mg · h/liter in the 600-mg, 900-mg, and 1,200-mg groups, respectively, reflecting a nonlinear increase in exposure with the dose (P < 0.001). Grade 3 adverse events occurred in only 2 patients in the 600-mg arm, 4 patients in the 900-mg arm, and 5 patients in the 1,200-mg arm. No significant differences in the bacteriological response were observed. Higher daily doses of rifampin (900 and 1,200 mg) resulted in a more than proportional increase in rifampin exposure in plasma and were safe and well tolerated when combined with other first-line anti-TB drugs for 2 months, but they did not result in improved bacteriological responses in patients with pulmonary TB. These findings have warranted evaluation of even higher doses of rifampin in follow-up trials. (This study has been registered at under identifier NCT00760149.).


drug safety; pharmacokinetics; rifampin; tuberculosis

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