Rifampicin (Rif) has a number of adverse effects, including cytochrome P450 3A (CYP3A) interactions, anaphylaxis, flu-like syndrome, thrombo-cytopenia and acute renal failure. As opposed to anaphylaxis, which is a type I reaction, the flu-like syndrome, thrombocytopenia and acute renal failure are type III reactions caused by anti-rifampicin antibodies [1]. Rifabutin (Rib) can be substituted in situations where CYP3A drug-drug interactions are undesirable. Successful substitution has previously been reported after hypersensitivity reactions to Rif. These reactions consisted of anaphylaxis in one [1] and a flu-like syndrome with a non-pruritic rash and thrombocytopenia in the other [2].Whilst the substitution of Rif with Rib is likely to be safe if done so for CYP3A interactions or non-hypersensitivity type reactions, the degree of cross-reactivity in reactions with an immunological basis is unclear. It has been previously reported that Rib can be substituted for Rif if such a hypersensitivity reaction were to occur [1,2]. We report the development of a flu-like syndrome and thrombocytopenia with the use of Rib after a previously similar reaction with Rif.
展开▼
