Rifampin has excellent penetration of biofilms in vitro (1). According to the Infectious Disease Society of America (IDSA) guidelines, it should be used in combination with another anti-staphylococcal antibiotic in the treatment of staphylococcal prosthetic joint infections for 3-6 months following debridement of a retained prosthesis (level A1 recommendation) (2).
Although a small randomized-controlled trial between ciprofloxacin and ciprofloxacin-rifampin reported a dramatic 100% cure rate in patients treated with the combination regimen (vs 58% with ciprofloxacin alone) (3), its small sample size (n=24) with its high drop-out rate, beg for a larger study comparing a more conventional anti-staphylococcal drug regimen such as a beta-lactam or vancomycin with and without rifampin. In the meantime, be on the alert for rifampin-induced drug resistance, hepatotoxicity, and frequent CYP450 drug interactions (e.g. warfarin) when used in combination with other anti-staphylococcal drugs (1).
- Forrest GN, Tamura K. Rifampin combination therapy for nonmycobacterial infections. Clin Microbiol Rev. 2010;23(1):14-34.
- Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1-e25.
- Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA. 1998;279(19):1537-1541.
Contributed by Sam Slavin, Harvard Medical Student, Boston, MA.