Provider Fact Sheet
Rifampin
Latent TB Infection (LTBI)
INH-resistant or intolerant
Overview
Many TB isolates are now resistant to isoniazid
(INH). Fortunately, most are sensitive to
rifampin. If a patient has known infection with
an INH- resistant, rifampin-sensitive TB germ
(their known source case TB isolate is INHresistant) or the patient does not tolerate
isoniazid, the second-line treatment is rifampin.
Many patients can tolerate INH if dosed
carefully (at bedtime with a small amount of
food and a big glass of water – and anticipating
that many people don’t feel quite right for the
first few weeks of INH treatment).
pretty well. Try it without the rifampin first to
get them used to swallowing without chewing.
Rifampin discolors urine and tears. Soft contact
lenses will be stained by rifampin.
Rifampin interacts with many prescription drugs
including coumadin, oral contraceptives, HIV
therapies, methadone, some anti-rejection drugs,
clarithromycin and many others.
Patients’ current medications should be reviewed
and they should be advised to inform other
providers that they are taking rifampin.
Adults
Rifampin 10 mg/kg/day in a single daily dose up
to 600 mg daily for 4 months.
Children
Rifampin 10 – 20 mg/kg/day in a single daily
dose up to 600 mg for 6 months
General
Rifampin comes as 150 mg and 300 mg
orange/red capsules. There is no commercially
available suspension, though pharmacists will
suspend a poorly homogeneous, unstable liquid
upon request. Alternatively, the capsules can be
opened into a dark colored, strongly flavored soft
vehicle for children daily. For children, I
suggest making a layer of vehicle on the bottom
of a spoon, putting a layer of rifampin powder
(from opening the capsule) and then topping
with more yummy vehicle (chocolate whipped
cream, syrup, jelly, etc). If the child can swallow
the spoonful without chewing, this trick works
Toxicity
Potential toxicities include gastrointestinal upset,
rash, hepatotoxicity, hypersensitivity and a flulike syndrome. Routine laboratory monitoring is
not indicated unless there are underlying issues
or medications.
Pediatric Rifampin daily dosing
Child's weight
Daily Rifampin dose
Kilograms
Pounds
Milligrams
150 mg
cap
300 mg
cap
4 - 7.5 kg
9 - 16 #
75 mg
1/2
0
7.5 - 12.5
17 - 27
150 mg
1
0
12.5 - 17.5
28 - 38
225 mg
1 1/2
0
17.5 - 25
39 - 55
300 mg
0
1
25 - 35
55 - 77
450 mg
1
1
> 35 kg
> 77 #
600 mg
0
2
Maximum daily rifampin dose is 600 mg
From Pediatric Tuberculosis: An Online Presentation by Ann Loeffler, MD. Produced by the Francis J. Curry National Tuberculosis Center.