       Document 0703
 DOCN  M9550703
 TI    Rifabutin: a review with emphasis on its role in the prevention of
       disseminated Mycobacterium avium complex infection.
 DT    9505
 AU    Maddix DS; Tallian KB; Mead PS; Pharmacy Service (119), VA Medical
       Center, San Francisco, CA; 94121.
 SO    Ann Pharmacother. 1994 Nov;28(11):1250-4. Unique Identifier : AIDSLINE
       MED/95152108
 AB    OBJECTIVE: To discuss the mechanism of action, in vitro and in vivo
       activity, pharmacokinetics, clinical trials, adverse effects, drug
       interactions, and dosage guidelines of rifabutin. DATA SOURCES:
       Pertinent literature published between 1982 and 1993 was identified via
       a MEDLINE search. Published proceedings of selected conferences were
       also reviewed. STUDY SELECTION: Selected basic science, microbiologic,
       and pharmacokinetic articles were evaluated. Because only limited data
       regarding rifabutin were available in the literature, all clinical
       trials involving the use of rifabutin in the prevention of Mycobacterium
       avium complex (MAC) infection in AIDS patients were reviewed. DATA
       SYNTHESIS: Rifabutin is a rifamycin derivative that was approved
       recently for the prevention of disseminated MAC disease in patients with
       advanced HIV infection. The drug has in vitro and in vivo activity
       against gram-positive bacteria, gram-negative bacteria, and
       mycobacteria. Two prospective, randomized, double-blind,
       placebo-controlled, multicenter trials demonstrated that rifabutin
       decreased the progression to MAC bacteremia in AIDS patients by about 50
       percent. Adverse effects that resulted in the discontinuation of
       rifabutin prophylaxis occurred in 16 percent of patients. Rifabutin
       induces hepatic enzymes to a lesser extent than does rifampin, but
       dosage adjustment of drugs that are known to interact with rifampin may
       be required. CONCLUSIONS: Rifabutin is the only drug shown to be
       effective in the prevention of MAC bacteremia in AIDS patients;
       therefore, it should be made available as a formulary agent. It may be
       reasonable to delay initiation of rifabutin prophylaxis until CD4
       lymphocyte counts are less than 75-50/mm3.
 DE    Acquired Immunodeficiency Syndrome/COMPLICATIONS  Bacteremia/*PREVENTION
       & CONTROL  Comparative Study  Double-Blind Method  Drug Interactions
       Female  Human  Male  Multicenter Studies  Mycobacterium
       avium-intracellulare Infection/*PREVENTION &  CONTROL  Randomized
       Controlled Trials  Rifabutin/ADVERSE
       EFFECTS/ECONOMICS/PHARMACOKINETICS/*THERAPEUTIC  USE  Risk Factors
       Species Specificity  JOURNAL ARTICLE  REVIEW  REVIEW, TUTORIAL

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

