Rifampicin (rifampin)

• Brand names: Rifadin, Rimactane
• Route: Oral and intravenous — always in combination

Rifampicin binds the beta subunit of bacterial DNA-dependent RNA polymerase and blocks transcription at the initiation step.

It penetrates biofilm and reaches bacteria in a slow-growing, metabolically quiet state that other antibiotics cannot kill — the reason it is added for prosthetic joint and device infection.

Resistance emerges within days if it is used alone, because a single point mutation in rpoB is enough, so it is always given with a partner drug.

• Adults: 300–450 mg twice daily, or 600 mg once daily, added to vancomycin, daptomycin or an oral agent.
• It is started only after the bloodstream has been cleared and any collection has been drained, not at the start of bacteraemia treatment.
• Courses for prosthetic joint infection often run 3–6 months alongside a companion antibiotic.
• Liver function should be monitored, and the drug interaction list checked before every prescription.

Doses listed are typical adult regimens quoted for reference. The actual dose, route and duration are decided by a clinician for the individual patient.

Rifampicin came from rifamycins isolated in 1957 from Amycolatopsis rifamycinica in a soil sample from a pine wood near Nice, France, by Lepetit researchers Piero Sensi and Maria Teresa Timbal.

The team named the family after the French crime film Rififi. Semi-synthesis produced rifampicin in 1965 and it reached the market in 1968.

It transformed tuberculosis treatment by shortening therapy from 18 months to six, and is on the WHO Essential Medicines List.

• Orange-red discolouration of urine, sweat, tears and contact lenses — harmless but startling if unexpected.
• Liver enzyme rises and hepatitis, particularly with other hepatotoxic drugs.
• Powerful induction of cytochrome P450 enzymes, reducing levels of warfarin, direct oral anticoagulants, hormonal contraception, antiretrovirals, statins and many others.
• Flu-like syndrome and low platelets, especially with intermittent dosing.

• Cornerstone of tuberculosis and leprosy treatment.
• Prophylaxis for close contacts of meningococcal and Haemophilus influenzae type b disease.
• Combination therapy for prosthetic joint infection and Brucella infection.