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Updated: Jun 21, 2025
Diagnosing Pulmonary Tuberculosis with the Xpert MTB/RIF Test
Published on: April 9, 2012
Characteristics of and treatment outcomes in rifampicin-intolerant patients
Background:
Rifampicin (RIF) is considered the backbone of TB treatment, but adverse effects often limit its use.
Methods:
This retrospective cohort study examined patients treated for TB disease at our institution, and compared those who received RIF to those who were intolerant to RIF.
Results:
A total of 829 patients were included. Seventy-six patients (9%) were intolerant to RIF. Patients with RIF intolerance were significantly older (median age: 67 years, IQR 50-78 vs. 48 years, IQR 31-70; P < 0.0001), and were more likely to be female (57% vs. 41%; P = 0.01) and have concurrent diabetes mellitus (37.3% vs. 19%; P < 0.0001) compared to those who tolerated RIF. RIF intolerance was most commonly due to transaminitis (25%), cytopenia (14.5%), rash (17.1%) and gastro-intestinal intolerance (7.8%). Twenty patients were subsequently challenged with rifabutin, and this was successful in 70%. The mean treatment duration was significantly longer in patients who were intolerant to RIF (335 vs. 270 days; P < 0.001). There was no significant difference in treatment outcomes.
Conclusion:
RIF intolerance is more common in older patients, females, and those with concurrent diabetes mellitus. Patients who could not tolerate RIF had a longer duration of therapy, but no difference in treatment outcomes. When attempted, rifabutin was well tolerated in most patients with a previous RIF-related adverse event.
Insights
Rifampicin intolerance is more common in older, female patients with diabetes. While it prolongs TB treatment, rifabutin is a viable alternative with good tolerance, ensuring similar outcomes.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Rifampicin is a cornerstone of tuberculosis treatment.
- Adverse effects of rifampicin can limit its clinical utility.
Purpose of the Study:
- To investigate the characteristics and outcomes of patients with rifampicin intolerance during TB treatment.
- To evaluate the efficacy and tolerability of rifabutin as an alternative in patients with rifampicin intolerance.
Main Methods:
- Retrospective cohort study of 829 patients treated for TB.
- Comparison of patients who received rifampicin versus those intolerant to it.
- Analysis of demographic factors, adverse event types, and treatment outcomes.
Main Results:
- 9% of patients were intolerant to rifampicin.
- RIF intolerance was associated with older age, female sex, and diabetes mellitus.
- Common causes included transaminitis, cytopenia, rash, and GI intolerance.
- Rifabutin was successful in 70% of patients challenged.
- RIF-intolerant patients had longer treatment durations but similar outcomes.
Conclusions:
- RIF intolerance is more prevalent in older, female patients with diabetes.
- Alternative agents like rifabutin can be effective for patients with RIF intolerance.
- Despite longer treatment, RIF intolerance does not impact TB treatment outcomes.
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