rifamycin

General

Pronunciation:
rif-a-mye-sin

Trade Name(s)

• Aemcolo

Ther. Class.

anti-infectives

Pharm. Class.

rifamycins

Indications

Travelers' diarrhea due to noninvasive strains of Escherichia coli.

Action

Inhibits bacterial synthesis by binding to bacterial DNA-dependent RNA polymerase.

Therapeutic Effect(s):

Decreased severity of travelers' diarrhea.

Escherichia coli (enterotoxigenic and enteroaggregative strains).

Pharmacokinetics

Absorption: Poorly absorbed (<0.1%), action is primarily in GI tract.

Distribution: Concentrated in gut.

Metabolism and Excretion: Primarily excreted in feces (86%).

Half-life: Unknown.

TIME/ACTION PROFILE (plasma concentrations)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity to rifamycin or other rifamycins;
• Diarrhea with fever or bloody stools;
• Diarrhea caused by other infectious agents.

Use Cautiously in:

• OB:  Use only if potential maternal benefit justifies potential fetal risk;
•  Lactation:  Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
• Pedi:   Safety and effectiveness not established.

Adverse Reactions/Side Effects

GI: CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD), constipation, dyspepsia

Neuro: headache

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None reported.

Route/Dosage

PO (Adults): 388 mg twice daily for 3 days.

Availability

Delayed-release tablets: 194 mg

Assessment

• Consult culture and susceptibility information, if available, and consider local epidemiology and susceptibility patterns in selecting or modifying antibacterial therapy.
• Assess abdomen, bowel sounds, abdominal pain, fever, amount and frequency of diarrhea, and whether stool is bloody. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD). May begin up to 2 or more months following cessation of therapy.

Implementation

• PO Administer 2 tablets twice daily in morning and evening for 3 days. Take each dose with 6–8 oz of water without regard to food.  DNC: Swallow tablets whole; do not crush, break, or chew.  Avoid alcohol.

Patient/Family Teaching

• Instruct patient to take rifamycin as directed.
• Advise patient to avoid use of alcohol during therapy.
• Advise patient to discontinue rifamycin if diarrhea persists more than 48 hr or worsens and to seek medical treatment for fever and/or or blood in the stools, and not to treat with antidiarrheals without consulting health care professional.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Decrease in symptoms of traveler's diarrhea.