ArticleThe Journal of antimicrobial chemotherapy2026
Pharmacokinetics of minocycline with and without rifampicin co-administration in patients with nontuberculous mycobacterial disease.
Article in The Journal of antimicrobial chemotherapy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesMinocycline demonstrates in vitro activity against Mycobacterium avium complex (MAC), but pharmacokinetic data in patients are limited. Additionally, co-administration with rifampicin may significantly alter minocycline pharmacokinetics. We evaluated the pharmacokinetics of minocycline with and without rifampicin co-administration in patients with nontuberculous mycobacterial (NTM) disease.
methodsThis one-arm, two-period, fixed-order study was conducted at Radboud University Medical Center in the Netherlands. Adults with NTM disease eligible for rifampicin-based therapy received two 5-day courses of minocycline 200 mg once daily, before and a month after initiating rifampicin in a once-daily dose of 450 mg (<50 kg) or 600 mg (≥50 kg). Minocycline pharmacokinetics were assessed over 24 h on Day 5 during both courses, i.e. at steady state. Rifampicin concentrations were evaluated concurrently during the second course. Non-compartmental and bioequivalence analyses were performed.
resultsEleven patients completed the first minocycline course; nine completed both. Geometric mean values (95% CI) of the total minocycline exposure (AUC0-24), peak concentration and pre-dose concentration without rifampicin co-administration were 58.4 mg·h/L (48.7-70.1), 5.2 mg/L (4.2-6.3) and 1.0 mg/L (0.8-1.3), respectively. The geometric mean ratio for the AUC0-24h of minocycline with versus without rifampicin was 49% (90% CI, 44.1-54.4), below the standard bioequivalence range of 80%-125%. All adverse events were graded mild or moderate. Nine (13%) were attributed to minocycline, primarily gastrointestinal, vestibular and headache-related.
conclusionsThis study provides data on minocycline pharmacokinetics in patients with NTM disease. Co-administration with rifampicin resulted in a halving of minocycline exposure, likely due to induction of drug-metabolizing enzymes and/or transporters.
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