Prevention of tuberculosis in susceptible close contacts or
those who have become tuberculin positive, who are
isoniazid-resistant
▶BY MOUTH
▶Child 1 month–11 years (body-weight up to
50 kg): 15 mg/kg daily for 6 months; maximum 450 mg
per day
▶Child 1 month–11 years (body-weight 50 kg and
above): 15 mg/kg daily for 6 months; maximum 600 mg
per day
▶Child 12–17 years (body-weight up to 50 kg): 450 mg daily
for 6 months
▶Child 12–17 years (body-weight 50 kg and above): 600 mg
daily for 6 months
Prevention of secondary case ofHaemophilus influenzae
type b disease
▶BY MOUTH
▶Child 1–2 months: 10 mg/kg once daily for 4 days
▶Child 3 months–11 years: 20 mg/kg once daily (max. per
dose 600 mg) for 4 days
▶Child 12–17 years: 600 mg once daily for 4 days
Prevention of secondary case of meningococcal meningitis
▶BY MOUTH
▶Neonate: 5 mg/kg every 12 hours for 2 days.▶Child 1–11 months: 5 mg/kg every 12 hours for 2 days
▶Child 1–11 years: 10 mg/kg every 12 hours (max. per dose
600 mg), for 2 days
▶Child 12–17 years: 600 mg every 12 hours for 2 days
Pruritus due to cholestasis
▶BY MOUTH
▶Child: 5 – 10 mg/kg once daily (max. per dose 600 mg)lUNLICENSED USENot licensed for use in children for
pruritus due to cholestasis.
lCONTRA-INDICATIONSAcute porphyrias p. 603 .jaundice
lCAUTIONSDiscolours soft contact lenses
lINTERACTIONS→Appendix 1 : rifampicin
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonNausea.thrombocytopenia.
vomiting
▶UncommonDiarrhoea.leucopenia
▶Frequency not knownAbdominal discomfort.acute kidney
injury.adrenal insufficiency.agranulocytosis.appetite
decreased.disseminated intravascular coagulation.
dyspnoea.eosinophilia.flushing.haemolytic anaemia.
hepatitis.hypersensitivity.influenza.intracranial
haemorrhage.menstrual disorder.muscle weakness.
myopathy.oedema.pseudomembranous enterocolitis.
severe cutaneous adverse reactions (SCARs).shock.skin
reactions.sputum discolouration.sweat discolouration.
tear discolouration.urine discolouration.vasculitis.
wheezing
SPECIFIC SIDE-EFFECTS
▶With intravenous useBone pain.gastrointestinal disorder.
hyperbilirubinaemia.psychotic disorder
▶With oral usePsychosis
SIDE-EFFECTS, FURTHER INFORMATIONSide-effects that
mainly occur with intermittent therapy include influenza-
like symptoms (with chills, fever, dizziness, bone pain),
respiratory symptoms (including shortness of breath),
collapse and shock, haemolytic anaemia,
thrombocytopenic purpura, and acute renal failure.
Discontinue if serious side-effects develop.lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with rifamycin hypersensitivity.
lCONCEPTION AND CONTRACEPTION
ImportantEffectiveness of hormonal contraceptives is
reduced and alternative family planning advice should be
offered.
lPREGNANCYManufacturers advise very high doses
teratogenic inanimalstudies infirst trimester; risk of
neonatal bleeding may be increased in third trimester.
lBREAST FEEDINGAmount too small to be harmful.
lHEPATIC IMPAIRMENTImpaired elimination.
Dose adjustmentsAvoid or do not exceed 8 mg/kg daily.
MonitoringIn patients with pre-existing liver disease or
hepatic impairment, monitor liver function regularly and
particularly frequently in thefirst 2 months; blood counts
should also be monitored in these patients.
lRENAL IMPAIRMENTUse with caution if doses above
10 mg/kg daily.
lMONITORING REQUIREMENTS
▶Renal functionshould be checked before treatment.
▶Hepatic functionshould be checked before treatment. If
there is no evidence of liver disease (and pre-treatment
liver function is normal), further checks are only necessary
if the patient develops fever, malaise, vomiting, jaundice
or unexplained deterioration during treatment. However,
liver function should be monitored on prolonged therapy.
▶Blood counts should be monitored in patients on
prolonged therapy.
lDIRECTIONS FOR ADMINISTRATION
▶With intravenous useDisplacement value may be significant,
consult local reconstitution guidelines; reconstitute with
solvent provided. May be further diluted with Glucose 5 %
orSodium chloride 0. 9 %toafinal concentration of
1. 2 mg/mL. Infuse over 2 – 3 hours.
lPRESCRIBING AND DISPENSING INFORMATIONIf treatment
interruption occurs, re-introduce with low dosage and
increase gradually.
▶With oral useIn general, doses should be rounded up to
facilitate administration of suitable volumes of liquid or an
appropriate strength of tablet. Doses may also need to be
recalculated to allow for weight gain in younger children.
Flavours of syrup may include raspberry.
lPATIENT AND CARER ADVICE
Soft contact lensesPatients or their carers should be advised
that rifampicin discolours soft contact lenses.
Hepatic disordersPatients or their carers should be told how
to recognise signs of liver disorder, and advised to
discontinue treatment and seek immediate medical
attention if symptoms such as persistent nausea,
vomiting, malaise or jaundice develop.
Medicines for Children leaflet: Rifampicin for meningococcal
prophylaxiswww.medicinesforchildren.org.uk/rifampicin-for-
meningococcal-prophylaxis
Medicines for Children leaflet: Rifampicin for the treatment of
tuberculosiswww.medicinesforchildren.org.uk/rifampicin-for-
treatment-of-tuberculosislMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Oral suspension
CAUTIONARY AND ADVISORY LABELS8, 14, 23
EXCIPIENTS:May contain Sucrose
▶Rifadin(Sanofi)
Rifampicin 20 mg per 1 mlRifadin 100 mg/ 5 ml syrup|
120 mlP£ 4. 27
Capsule
CAUTIONARY AND ADVISORY LABELS8, 14, 23
▶Rifampicin (Non-proprietary)
Rifampicin 150 mgRifampicin 150 mg capsules| 100 capsuleP
£ 50. 49 DT = £ 50. 49
Rifampicin 300 mgRifampicin 300 mg capsules| 100 capsuleP
£ 123. 89 DT = £ 123. 87BNFC 2018 – 2019 Tuberculosis 365
Infection5