Rates and risk factors for discontinuation of rifampicin

SETTING: All patients with culture-confirmed, rifampin-susceptible Mycobact erium tuberculosis diagnosed during a 20-month period in New York City, who were started on a rifampin-containing regimen and received greater than or equal to 60 days of treatment. OBJECTIVE: TO identify rates of and reasons for rifampin discontinuation. DESIGN: Retrospective case-control study using surveillance data and medica l record reviews. Discontinuation due to thrombocytopenia, creatinine >2.0 mg/dl, bilirubin >2.0 mg/dl or severe reactions (generalized rash, persiste nt drug fever, or severe interference with methadone metabolism) were defin ed as appropriate for discontinuation of rifampin. hll other reactions were classified as inappropriate. RESULTS: Of 3520 patients, rifampin was discontinued in 68 (1.9%); of these , 57% had rifampin discontinued unnecessarily. Treatment by an inexperience d provider (adjusted odds ratio [ORadj] 4.0; 95% confidence interval [CI] 1 .9-8.5), race (ORadj 3.1; 95%CI 1.4-6.9), his tory of previous treatment (O Radj 4.8; 95%CI 1.9-12.5), and history of methadone drug treatment (ORadj 1 2.6; 95%CI 5.3-29.9) were all associated with inappropriate rifampin discon tinuation. CONCLUSION: True intolerance was rare, even among those patients infected w ith the human immunodeficiency virus. Most patients with minor reactions ca n successfully complete treatment with rifampin, particularly if managed by a physician experienced in the treatment of tuberculosis.