Rifampin/Rifampicin for Non-Mycobacterial Infections

Antibiotic Class:


Antimicrobial Spectrum:

Staphylococcus spp.(including aureus), Streptococcus spp.(including S. pneumoniae), Legionella spp., B. fragilis, Y. pestis,C. burnetti, Neisseria meningitides

Mechanism of Action:

Rifamycins bind to and inhibit DNA-dependant RNA polymerase


Concentration dependent killing (peak/MIC and AUC/MIC)


Cmax: 8-24mg/L; Tmax: 1.5-2 hours; Bioavailability: 68%; Protein binding: 85%; Table 3

Adverse Effects:

Hepatic: hepatotoxicity, jaundice, hepatitis

Hematologic: Thrombocytopenia, hemolytic anemia

Kidneys: Acute renal failure, interstitial nephritis,

Other: shock, flu-like syndrome, body fluid discoloration (tears, sweat may be orange colored)


PO: 150mg, 300mg capsules

IV:  600mg as a 30 minute infusion

Dosing in adults:

Prophylaxis, Meningococcal infectious disease: 600 mg PO q12h x 2 days

Prosthetic valve endocarditis (S. aureus): 900-1200 mg/day PO/IV divided q8h, in combination with anti-staphylococcal penicillin with or without gentamicin

Synergistic activity against Staphylococcal infections: 300-600 mg IV/PO q12h

Table 6

Disease state based dosing:

Hepatic failures: No specific recommendations, however, half-life is prolonged in patients with hepatic insufficiency

Renal failures: No adjustment necessary.


Precautions: Hepatic impairment

Drug Interactions:

Due to its known induction of P450 liver isoenzymes, caution should be exercised when administering this agent with other drugs metabolized in the liver. Please see the “Drug Interactions” section in the text/website for a complete list of relevant interactions. Heparin may negate the action of rifampin.


Category C: Risk unknown. Human studies inadequate

Monitoring Requirements:

Toxic: baseline liver function tests, bilirubin, serum creatinine, complete blood count and platelet count.

Brand names/Manufacturer:

Rifampin (Various manufacturers worldwide)

Rifadin - Hoechst Marion Roussel

Rimycin - Alphapharm

Rofact - Valeant Pharmaceuticals