Rifampicin use in MRSA infections: will it add to the emergence of multidrug-resistant tuberculosis in developing countries?

Abstract

disease may develop at any time later, depending on his or her immune status. Trials have shown that the use of rifampicin as monotherapy in latent TB prophylaxis may not lead to the emergence of resistance, whereas in active disease such therapy may do so. The presence of MRSA, as with any infection, may decrease the immune status and may cause a fl are up of a latent disease. The clinical impact of multidrug-resistant (MDR) TB is enormous: the rate of treatment failure with standard regimens is high, and treatment with second-line regimens is toxic, is expensive, and is associated with a substantial incidence of treatment failure and death. For this reason, efforts to “protect” rifampicin have been promulgated by organizations such as the World Health Organization and the International Union Against Tuberculosis and Lung Disease. These measures include restriction of rifampicin use to the treatment of active TB, promotion of the use of fi xed-dose combinations to prevent monotherapy, the use of non-rifampicin-containing regimens during the continuation phase of TB treatment, and supervision of the administration of all rifampicin-based regimens. The use of rifampicin for indications other than active TB, and the self-administration of rifampicin are strongly discouraged by these organizations. An important, unresolved question regarding the use of rifampicin regimens for indications other than TB is whether their use will result in the development of rifampicinresistant TB. However, what is very well known is that rifampicin is the cornerstone of modern therapy for TB. The effective prevention and control of infections caused by MRSA depends on the practice of infection-control measures such as hand-washing, theater discipline, and respect for soft tissues during surgery. Minimizing risk factors and paying attention to alternative cost-effective therapies, as per guidelines, may ease the problem of the management of MRSA infections and at the same time not add to the emergence of MDR TB. Received: April 11, 2008 / Accepted: September 2, 2008