rifampin

[Guest guest]

> Useless drug IMO. Shoemaker didn't win too many fans with his

choice

> of rifampin and bactrim. I actually found rifampin to build

> resistance extremely quickly to your sinus bugs.

> tony

Rif + doxy in one of the 2 most impressive trials of abx for

idiopathic disease that I know of:

J Rheumatol. 2004 Oct;31(10):1973-80. Links

Doxycycline versus doxycycline and rifampin in undifferentiated

spondyloarthropathy, with special reference to chlamydia-induced

arthritis. A prospective, randomized 9-month comparison. JD,

Valeriano J, Vasey FB.

Division of Rheumatology, University of South Florida, Tampa, Florida

33612, USA. jocarter@...

OBJECTIVE: Chlamydia is a known trigger of reactive arthritis (ReA).

It may also be common cause of undifferentiated spondyloarthropathy

(uSpA). Persistent, metabolically active, Chlamydiae have been

observed in the synovial tissue of these patients years after their

initial exposure. Trials with lymecycline and rifampin have shown

benefit in early/acute Chlamydia-induced arthritis. In vitro data

suggest that persistent Chlamydia become resistant to chronic

monotherapy of tetracyclines or rifampin, whereas no such resistance

is noted when rifampin is added to antimicrobials that are active

against Chlamydia. Rifampin and doxycycline also show synergistic

effect against Chlamydia. In addition, rifampin inhibits chlamydial

production of heat shock proteins (HSP). HSP60 plays a key role in

the chronic persistent state of Chlamydia. We conducted a

prospective, randomized 9-month trial to evaluate the efficacy of

doxycycline versus a combination of doxycycline and rifampin in the

treatment of uSpA. METHODS: The study enrolled 30 patients with

chronic inflammatory arthritis (average disease duration 10 yrs) who

fulfilled the European Spondylarthropathy Study Group criteria, with

no evidence of inflammatory bowel disease, psoriasis, ankylosing

spondylitis, or preceding dysentery. Patients received doxycycline

100 mg po twice daily or a combination of doxycycline 100 mg po twice

daily and rifampin 600 mg po daily. They received a 4-question self-

questionnaire and a blinded joint examination at each visit. The

questions include a visual analog scale (VAS) for their current

amount of back pain, duration of morning stiffness, back pain at

night, and peripheral joint pain. The blinded joint examination

consisted of a swollen joint count (SJC) and a tender joint count

(TJC). These 6 variables were assessed at baseline and at 1, 3, 6,

and 9 months. Responders were defined as those who improved > or =

20% in at least 4 of the 6 variables at 9 months of therapy. RESULTS:

Comparing the doxycycline + rifampin arm (D/R) versus the doxycycline

arm (D) at 9 months of therapy, all 6 variables improved more in D/R

versus D, 4 of which were statistically significant. The mean VAS

(scale of 100) decreased 24.4 points in D/R in contrast to 3 points

in D (p < 0.03). Duration of morning stiffness decreased by 1.2 h in

D/R, with a slight increase of 0.1 h in D (p < 0.003). The back pain

at night and peripheral joint pain both improved in D/R group versus

D (not statistically significant). Finally, the SJC and TJC also

improved in D/R (-2.1 and -2.5) versus D (-0.4 and -0.6; p = 0.02, p

= 0.03, respectively). Eleven of 15 patients in the D/R arm were

responders, whereas only 2 of 15 D group patients were considered

responders (p < 0.003). CONCLUSION: The combination of doxycycline

and rifampin for 9 months seemed to be effective in treatment of

chronic uSpA. This is the first study to demonstrate therapeutic

benefit with antimicrobials to a chronic inflammatory arthritis

possibly secondary to persistent Chlamydia.

PMID: 15468362 [PubMed - indexed for MEDLINE]