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Recurrent disseminated intravascular coagulation caused by intermittent dosing of rifampin

Thomas C Havey1, Christine Cserti-Gazdewich, Michelle Sholzberg

  • 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada. tom.havey@utoronto.ca

The American Journal of Tropical Medicine and Hygiene
|February 4, 2012
PubMed

Insights

Intermittent rifampin therapy can cause severe immunoallergic reactions, including disseminated intravascular coagulation. Healthcare providers should investigate a patient's full rifampin exposure history before initiating intermittent treatment.

Area of Science:

  • Pharmacology
  • Infectious Diseases
  • Toxicology

Background:

  • Rifampin is a key antibiotic for treating Mycobacterium leprae (leprosy).
  • Daily rifampin administration is generally well-tolerated.
  • Intermittent or interrupted rifampin dosing is linked to severe adverse events.

Observation:

  • A case of recurrent disseminated intravascular coagulation (DIC) in a patient with Mycobacterium leprae infection following intermittent rifampin exposure is presented.
  • Eight previously reported cases of rifampin-associated DIC were reviewed.
  • Most patients with DIC had prior rifampin exposure and received intermittent dosing.

Findings:

  • Clinical manifestations of rifampin-associated DIC include fever, hypotension, abdominal pain, and vomiting shortly after drug intake.
  • Reactions typically occurred within 3-6 doses when rifampin was administered monthly.
  • A significant fatality rate of 37.5% was observed in the reported cases.

Implications:

  • A thorough patient history of previous rifampin exposure is crucial before prescribing intermittent therapy.
  • Awareness of these risks is vital for clinicians managing leprosy and other infections treated with rifampin.
  • This highlights the importance of precise dosing schedules to mitigate severe drug reactions.

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