ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2020
Subtherapeutic Rifampicin Concentration Is Associated With Unfavorable Tuberculosis Treatment Outcomes.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 3 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Studying intrapulmonary pharmacokinetics for tuberculosis treatment: a systematic review of methodology.The Journal of antimicrobial chemotherapy · 2025Pooled it
- Rifampicin Exposure in Tuberculosis Patients with Comorbidities in Sub-Saharan Africa: Prioritising Populations for Treatment-A Systematic Review and Meta-analysis.Clinical pharmacokinetics · 2025Pooled it
- Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies.PLoS medicine · 2024Pooled it
- Effect of kidney function on drug concentrations of first-line anti-tubercular treatment.Infection · 2026Article
- Assessment of drug therapy problems and associated factors among PLWHA and tuberculosis admitted to two referral hospitals in Lusaka, Zambia.BMC infectious diseases · 2026Observational
- Pharmacokinetic and pharmacogenomic predictors of hepatotoxicity in the HIRIF trial for drug-susceptible tuberculosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Common Adverse Reactions and Management Strategies of First-Line Anti-Tuberculosis Drugs.Infection and drug resistance · 2026Review
- Sex-dependent variability of isoniazid and rifampicin serum levels in patients with tuberculosis.Infection · 2025Article
- Identification of Factors Determining Patterns of Serum C-Reactive Protein Level Reduction in Response to Treatment Initiation in Patients with Drug-Susceptible Pulmonary Tuberculosis.Antibiotics (Basel, Switzerland) · 2024Article
- Variability in plasma rifampicin concentrations and role ofInfectious diseases (London, England) · 2024Article
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- Rifampin urinary excretion to predict serum targets in children with tuberculosis: a prospective diagnostic accuracy study.Archives of disease in childhood · 2023Article
- Management of Polypharmacy and Potential Drug-Drug Interactions in Patients with Mycobacterial Infection: A 1-Year Experience of a Multidisciplinary Outpatient Clinic.Antibiotics (Basel, Switzerland) · 2023Article
- Sex Differences in TB Clinical Presentation, Drug Exposure, and Treatment Outcomes in India.Chest · 2023Article
- Pharmacokinetic study of high-dose oral rifampicin in critically Ill patients with multidrug-resistant Acinetobacter baumannii infection.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2022Article
- The Impact of First-Line Anti-Tubercular Drugs' Pharmacokinetics on Treatment Outcome: A Systematic Review.Clinical pharmacology : advances and applications · 2021Article
- Individualized Dosing With High Inter-Occasion Variability Is Correctly Handled With Model-Informed Precision Dosing-Using Rifampicin as an Example.Frontiers in pharmacology · 2020Article
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25 authors.
Funding
Abstract
backgroundThe relationships between first-line drug concentrations and clinically important outcomes among patients with tuberculosis (TB) remain poorly understood.
methodsWe enrolled a prospective cohort of patients with new pulmonary TB receiving thrice-weekly treatment in India. The maximum plasma concentration of each drug was determined at months 1 and 5 using blood samples drawn 2 hours postdose. Subtherapeutic cutoffs were: rifampicin <8 µg/mL, isoniazid <3 µg/mL, and pyrazinamide <20 µg/mL. Factors associated with lower log-transformed drug concentrations, unfavorable outcomes (composite of treatment failure, all-cause mortality, and recurrence), and individual outcomes were examined using Poisson regression models.
resultsAmong 404 participants, rifampicin, isoniazid, and pyrazinamide concentrations were subtherapeutic in 85%, 29%, and 13%, respectively, at month 1 (with similar results for rifampicin and isoniazid at month 5). Rifampicin concentrations were lower with human immunodeficiency virus coinfection (median, 1.6 vs 4.6 µg/mL; P = .015). Unfavorable outcome was observed in 19%; a 1-μg/mL decrease in rifampicin concentration was independently associated with unfavorable outcome (adjusted incidence rate ratio [aIRR], 1.21 [95% confidence interval {CI}, 1.01-1.47]) and treatment failure (aIRR, 1.16 [95% CI, 1.05-1.28]). A 1-μg/mL decrease in pyrazinamide concentration was associated with recurrence (aIRR, 1.05 [95% CI, 1.01-1.11]).
conclusionsRifampicin concentrations were subtherapeutic in most Indian patients taking a thrice-weekly TB regimen, and low rifampicin and pyrazinamide concentrations were associated with poor outcomes. Higher or more frequent dosing is needed to improve TB treatment outcomes in India.
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