Sunday, April 9, 20231

RIFAMPICIN INDUCED THROMBOCYTOPENIA

(Rajiv Garg, V. Gupta, S. Mehra, R. Singh and R.Prasad)[Indian J Tuberc 2007]

-Rishikesh H. Autade M.Sc.

(IV Sem)

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“It happens every time! Doc. When I eat Anti-tubercular Drug, immediately develop this nasty rasher on all over my body. My wife thinks that I m Alien.”

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Tuberculosis Mycobacterium

tuberculosis. Transmission. How does

bacteria enters in to Macrophage?

How lesions are formed?

Symptoms.

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Treatment of Tuberculosis Isoniazid -Catalase oxidase Rifampicin -DNA dependent RNA polymerase. Streptomycin -30s Ribosome Ethanmbutanol -Bacterial cell wall Pyraziamide -DNA Replication.

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Rifampicin(1967)

Amycolaptosis rifacolatopsis.

Metabolism

C43H58N4O12

Mycolic acid And Peptidoglycan

How does bacteria get resistance to Rifampicin?

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Adverse Effect (Thrombocytopenia)

Thrombocytopenia is the term used for a reduced platelet (Thrombocyte) count.

150 to 400 million/ml

Platelet- Blood clotting

What is the effect of reduced platelet count?

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Rifampicin

Glycoprotein

Platelet Platelet removed from blood

Drug dependent AntibodyConf. Change in

Glycoprotein

How does rifampicin causes thrombocytopenia?

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Case Study Prpura means

bleeding is seen on the skin in the form of tiny pin prick hemorrhages.

1st evidence of Rafampicin induced thrombocytopenia.

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Discussion

Criteria's for Thrombocytopenia Differentiation.

Major bleeding

-Intracranial and Retroperitoneal

Minor bleeding

-Excessive menstrual bleeding

Trivial bleeding

-Purpurae all over body, Epistaxis.

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Thrombocytopenia

- Ethambutanol, Pyrazinamide. Keep eye on platelet count during

treatment. Use new drugs while restarting the

therapy. Offending drug should not be used again.

Discussion Cont….

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Ethical Issues

Rifampicin was given to the patient with informed consent.

Ethical concerns would have arisen if- - New drug - Without Patients permission.

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Current Research In T.B.

Project - 2001 with EU And WHO.

Gatifloxacin-Reduces treatment period.

Phase II trials- South Africa.

public and private partners.

Expected to come- End of 2009.

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An Apple a day keep Dr. away.

Sunday, April 9, 202314

References

James N George et al. Drug induced thrombocytopenia a systematic review of published case reports. Ann Intern

Med 1998; 129: 886-890. Rifampicin – Sister Mary Gabriel,

Ruttonjee Snatorium, Hong Kong. Pg no. 47-54(the bulletin of hong Kong Medcal Association Vol.25, 1973).