Rifampin is the first-line treatment against mycobacterial infections. Rifampin has activity against N. gonorrhoeae, staphylococci, streptococci, Mycobacterium leprae, MAC, and H. influenza type b. Rifabutin is active against most Mycobacterium spp (Woo & Robinson, 2016). Since rifampin resistance develops rapidly when used alone, it should be combined with another active antibiotic for treatment of established infections (Woo & Robinson, 2016).
Rifampin is also used as prophylaxis for close contacts of people with meningococcal infections caused by N. meningitidis, Including household members, children and personnel in nurseries and day-care centers, and closed populations such as in college dormitories and military barracks (Woo & Robinson, 2016). Rifampin is also a prophylaxis for close contacts of people with actual or suspected infections with H. influenza type b. If one of the contacts in a household is an unvaccinated child 4 years or younger, it is recommended that all contacts in the household, except pregnant women (Woo & Robinson, 2016).
Antifungals used mainly as topical preparations include butoconazole (Gynazole-1), ciclopirox (Loprox), clotrimazole (Gyne-Lotrimin, Lotrimin, Mycelex), econazole (Spectazole), ketoconazole (Nizoral), miconazole (Micatin, Monistat), naftifine (Naftin), nystatin (Nystop, Nyamyc), oxiconazole (Oxistat), terconazole (Terazol), tioconazole (Vagistat), and tolnaftate (Tinactin, Absorbine, Aftate) The most common adverse reactions associated with rifamycins are GI in nature: anorexia, nausea, vomiting, diarrhea, flatulence, and abdominal pain (Woo & Robinson, 2016). Hepatotoxicity leading to hepatitis occurs with rifampin. Transient elevations of AST/ALT are seen in the first 8 weeks of therapy in 10% to15% of patients. However, less than 1% of patients have progressive hepatotoxicity (Woo & Robinson, 2016). A harmless orange-red discoloration of body fluids, including tears, saliva, urine, sweat, CSF, and feces, also occurs (Woo & Robinson, 2016). Additional adverse reactions include blood dyscrasias, headache, drowsiness and inability to concentrate, a pruritic rash (1% to 11% of patients), visual disturbances, lupus erythematosus, and exudative conjunctivitis (Woo & Robinson, 2016). Linezolid was originally developed as an MAOI and is a nonselective inhibitor of monoamine oxidase (Woo & Robinson, 2016).
Linezolid interacts with adrenergic drugs, increasing the action of the interacting drug (Woo & Robinson, 2016).
Concurrent use with MAOIs and SSRIs, tricyclic antidepressants, ondansetron, meperidine, buspirone, methadone, and tramadol increases the risk of serotonin syndrome (Woo & Robinson, 2016). Tyramine-rich foods and drinks can interact with linezolid resulting in highly elevated blood pressure