Table 1. Rifampin Activity Against Mycobacteria (79)

Organism

 #  isolates

MIC50 mg/ml

 MIC90 mg/ml

Range or MIC (unspecified) mg/ml

 

 

 

 

 

Mycobacteria

 

 

 

 

 

Mycobacterium abscessus

 

1

 

 

>20

Mycobacterium acapulcensis

 

1

 

 

2.5

Mycobacterium asiaticum

 

10

 

 

>1

Mycobacterium aurum

 

1

 

 

10

Mycobacterium avium-intracellulare complex

 

35

52

523

16

 

<0.12

6.25

10

2.0

2

50

 

8.0

<0.12-4

0.78->100

 

0.25-16

Mycobacterium borstelense

 

1

 

 

>20

Mycobacterium bovis

 

38

     

 1   

 

Mycobacterium bovis-BCG

 

22

    

 1   

 

Mycobacterium celatum

 

2

 

 

128-256

Mycobacterium chelonae

 

15

60

16

>64

 

64

 

>64

>5

>64

 

0.25->256

Mycobacterium chelonae subsp. abscessus

 

1

20

 

>100

 

>100

 

50

50->100

Mycobacterium chelonae subsp. chelonae

 

20

>100

>100

25->100

Mycobacterium chelonae-fortuitum

 

5

>16

 

0.25->16

Mycobacterium chitae

 

2

 

 

10-20

Mycobacterium diernhoferi

 

1

 

 

20

Mycobacterium fallax

 

10

<0.25

4

<0.25-16

Mycobacterium flavescens

 

1

15

 

 

25

>1

 

Mycobacterium fortuitum

 

18

17

10

30

9

28

20

>64

5

 

>10

>8

64

50

 

>64

>20

 

 

 

 

100

16->64

 

>16

 

>8

0.125->256

12.5-100

Mycobacterium gastri

 

4

1

 

 

Mycobacterium gordonae

 

32

141

 

1

1a

1a

 

Mycobacterium haemophilum

 

17

3

0.5

1.0

0.5-2.0

0.25-1

 

Mycobacterium intracellulare

20

0.5

2

 

Mycobacterium kansasii

 

6

10

13

32

8

1

10

19

71

 

 

1.25

<0.25

 

1

 

0.25

0.2

1.0

 

1.25

0.5

1a

 

 

 

3.13

0.1-0.5

 

 

1a

 

1

0.125-0.5

0.025-3.13

Mycobacterium leprae

 

N/A

 

 

(<1)

Mycobacterium malmoense

 

1

47

 

1

 

 

1

Mycobacterium marinum

 

 

 

 

 

17

12

10

1

28

10

11

5

10

33

 

0.5

 

 

 

 

 

 

0.25

0.2

 

1

1a

 

 

 

 

 

 

0.39

1.0a

 

1a

0.4-1.6

1.25

(1)

(1.56)

1.25-2.5

0.25-0.5

0.1-0.39

1.0a

Mycobacterium microti

 

1

 

 

0.0025-0.040

Mycobacterium parafortuitum

 

1

1

 

 

10

50

 

Mycobacterium phlei

12

1

 

<0.32

 

0.6

Mycobacterium runyonii

 

1

 

 

>20

Mycobacterium scrofulaceum

19

19

51

 

1.56

0.78

 

12.5

6.25

 

0.1-6.25

>1

Mycobacterium simiae

 

3

2

28

 

 

>10a

>10a

>25

(>1)

 

Mycobacterium smegmatis

 

1

27

2

 

>16

 

>16

17

4->16

50

 

Mycobacterium szulgai

 

23

9

1

 

1

 

5.0a

1.0a

 

5.0 a

1.0 a

Mycobacterium terrae

 

7

64

 

 

5

1-5

>1

Mycobacterium thermoresistibile

 

 

1

1

1

 

 

1

1

1

Mycobacterium trivale

 

2

 

1a

1a

Mycobacterium tuberculosis

 rifampicin-sensitive

 

16

0.1

0.2

0.025-0.2

Mycobacterium tuberculosis

 rifampicin-resistant

 

6

100

100

50-100

Mycobacterium ulcerans

 

N/A

 

 

(0.005-0.2)

Mycobacterium vaccae

 

1

1

 

 

2.5

6.25

 

Mycobacterium xenopi

 

 

 

 

3

34

1

25

40

7

 

1

 

 

 

1a

 

 

1

1a

 

<1u ,1.5v

 

0.5-2

1

 

  

Table 2. Rifabutin Activity Against Mycobacteria (79)

Organism

 #  isolates

MIC50 mg/ml

 MIC90 mg/ml

Range or MIC (unspecified) mg/ml

Mycobacteria

 

 

 

 

 

Mycobacterium avium complex

 

52

523

21

16

 

0.39

 

0.5

0.5

1.56

2.0

2

1.0

0.025-100

 

0.25-64

0.063-2.0

Mycobacterium bovis

 

N/A

 

 

(<2)

Mycobacterium celatum

 

2

2

 

 

 

0.5

8

Mycobacterium chelonae

 

 

18

N/A

N/A

60

 

32

64

 

 

(>2.0)

2-64

(32)

(>5)

 

Mycobacterium chelonae subsp. abscessus

 

20

12.5

25

 

3.13-25

 

Mycobacterium chelonae subsp. chelonae

 

20

12.5

50

3.13-50

Mycobacterium fallax

 

 

10

N/A

<0.25

1

<0.25--1

(<2)

Mycobacterium flavescens

N/A

 

 

(>5)

Mycobacterium fortuitum

 

 

17

28

N/A

20

30

 

1.25

1

 

3.13

>2.0

2.5

8

 

6.25

 

 

<0.25-8

(>5)

1.56-6.25

 

Mycobacterium gastri

 

N/A

 

 

(<1)

Mycobacterium gordonae

 

32

N/A

 

0.5a

0.5a

(<1)

Mycobacterium haemophilum

 

17

3

 

<0.03

<0.03

<0.03-0.06

0.25-1

Mycobacterium intracellulare

 

20

0.25

1

 

Mycobacterium kansasiii

 

 

 

10

13

21

32

19

0.075

<0.25

 

 

0.025

0.075

<0.25

 

 

0.1

 

 

0.25a

0.5a

<0.0125-0.2

Mycobacterium malmoense

 

1

 

 

0.12

Mycobaacterium marinum

 

17

12

N/A

10

<0.25

 

 

0.1

 

<0.25

 

 

0.1

 

0.5a

(<1)

0.025-0.2

Mycobacterium microti

 

N/A

1

 

 

(<2)

0.0015-0.026

Mycobacterium paratuberculosis

 

8

0.06

 

0.03-0.25

Mycobacterium phlei

 

N/A

 

 

(<2)

Mycobacterium scrofulaceum

 

N/A

N/A

19

 

 

0.2

 

 

 

1.56

(<2)

(<1)

0.025-100

Mycobacterium simiae

 

3

N/A

1

1

 

 

 

>2a

(>5)

0.5

8

Mycobacterium smegmatis

 

27

4

8

1-8

Mycobacterium szulgai

N/A

 

 

(>5)

Mycobacterium terrae

 

7

N/A

 

1.0a

(0.5b)

(<1)

Mycobacterium thermoresistibile 

 

1

1

 

 

2.0

0.5

Mycobacterium triviale

N/A

 

 

(<1)

Mycobacterium tuberculosis

 rifampicin-sensitive

 

16

180

0.025

 

0.5

0.025-0.05

0.5a

Mycobacterium tuberculosis

 rifampicin-resistant

 

6

122

12.5

2.0

12.5

6.25-12.5

Mycobacterium ulcerans

 

N/A

 

 

(<2)

Mycobacterium xenopi

 

3

N/A

40

1

1

 

 

 

0.5

0.5a

(<1)

0.5-2

0.5

0.1d ,0.25e

 

Table 3. Pharmacologic and Pharmacodynamic Characteristics of the Three Currently Available Rifamycin Antibiotics (18)

Feature

Rifampin 600 mg

(twice weekly)

Rifabutin 300 mg

(twice weekly)

Rifapentine 600 mg

(once weekly)

Bioavailability (%)

68

20

Unknown

Range of Tmax

(time to Cmax; hr)

1.5-2.0

2.5-4.0

5-6

Range of Cmax (mcg/ml)

8-24

0.2-0.6

8-30

Effect of food

Decrease AUC 6%

Decrease Cmax 36%

AUC & Cmax unchanged;

Tmax increased

Increase AUC 40-50%

Effect of antacids

None

None (didanosine)

Unknown

Major metabolic pathway

Deacetylation, hydrolysis to formyl derivatives

CYP3A-mediated hydroxylation, deacetylation

Deacetylation, hydrolysis to formyl derivatives

Range of serum half-life (hr)

2-5

32-67

14-18

Effect on CYP3A

Pronounced

Weak

Moderate

Auto-induction

Yes

Yes

No (or slight)

Effect on indinavir AUC (example of CYP3A induction)

92% decrease

34% decrease

70% decrease

Change in AUC when given with a CYP3A inhibitor

No effect

293% increase

No effect

Typical Cmax (mcg/ml)

10.0

0.45

15.0

MIC in broth culture (mcg/ml)

0.15

0.06

0.04

Binding to plasma proteins (%)

85%

71-85%

97%

 

Table 4. Comparison of Rifapentine trials in HIV-Negative TB

Feature

Hong Kong

HMR 008

TBTC Study 22 

Induction regimen

(initial 2 months

of treatment)    

2 (HRZS)3

2 HRZE, or 2 (HZE)7P2

2 (HRZE/S)7, or

˝ (HRZE/S)7 1˝HRZE/S)2

 

No. doses                    

72, 40, 35

88, 72

58-76, 42-60

Continuation regimen

(after the first 2 months of treatment)

4 (HR)3

4 (HP)1

4(HP)1:2/3

4 (HR)2

4 (HP)1

4 (HR)2

4 (HP)1

 

 

 

 

Life table rate of F/R in 4(HR)2 or 3

4.2%

Estimated 8%

5.9%

 

Life table rate of F/R in 4(HP)1

10.2%

Estimated 14%

10.3%

 

Table legend: E = ethambutol, H = isoniazid, P = rifapentine, R = rifampin,

S = streptomycin, Z = pyrazinamide. Number indicates how many months of treatment; subscript number indicates the number of doses per week.

 

Figure 1. Structure of 3 Rifamycins

 

Figure 2. Hypothesized Populations of TB Bacilli relative to Drug Effects