Adequacy of Rifampin Absorption after Jejunostomy Tube Administration

It is not always possible to administer antituberculosis pharmacotherapy orally for reasons that may be a direct consequence of tuberculosis itself. To our knowledge, no published literature is available regarding antituberculosis drug absorption via feeding tube. We present the case of a patient wi...

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Bibliographic Details
Published in:Pharmacotherapy 2016-04, Vol.36 (4), p.e23-e25
Main Authors: Stott, Katharine E., Singh, Bhagteshwar, Beadsworth, Mike B.J., Vaudrey, Kate, Khoo, Saye H., Davies, Geraint
Format: Article
Language:English
Subjects:
Administration, Mucosal
Antibiotics, Antitubercular - administration & dosage
Antibiotics, Antitubercular - blood
Antibiotics, Antitubercular - pharmacokinetics
Antibiotics, Antitubercular - therapeutic use
Case Report
Case Reports
Deglutition Disorders - etiology
Deglutition Disorders - surgery
dysphagia
Endoscopy, Gastrointestinal - adverse effects
Humans
Intestinal Absorption
Intestinal Mucosa - metabolism
jejunal absorption
jejunal feeding
Jejunostomy - adverse effects
Jejunum - metabolism
Male
meningitis
Middle Aged
pharmacokinetics
rifampicin
rifampin
Rifampin - administration & dosage
Rifampin - blood
Rifampin - pharmacokinetics
Rifampin - therapeutic use
tuberculosis
Tuberculosis, Meningeal - blood
Tuberculosis, Meningeal - drug therapy
Tuberculosis, Meningeal - metabolism
Tuberculosis, Meningeal - physiopathology
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Summary:It is not always possible to administer antituberculosis pharmacotherapy orally for reasons that may be a direct consequence of tuberculosis itself. To our knowledge, no published literature is available regarding antituberculosis drug absorption via feeding tube. We present the case of a patient with tuberculosis meningitis who required medication administration via percutaneous endoscopic jejunostomy (PEJ) tube. Blood samples were collected during the continuation phase of antituberculosis therapy, immediately before dose administration, and then at 1, 2, 4, and 6 hours after dose administration for quantification of serum rifampin concentrations. Assaying these concentrations by high‐pressure liquid chromatography demonstrated a peak serum rifampin level (Cmax) of 18 μg/ml and total rifampin exposure (area under the curve from 0–6 hours [AUC0–6]) of 50.1 μg/ml. These are high compared with rifampin Cmax and AUC0–6 values reported in patients after oral rifampin administration; Cmax tends to range between 4.0–10.5 μg/ml and AUC0–6 7.0–52.9 μg/ml after oral administration of 600 mg at steady state. Based on our patient's results, therefore, rifampin administered by PEJ tube appears to be well absorbed, with preservation of adequate Cmax and AUC values. It is worth noting that this was in the context of drug administration in the fasted state. In the absence of any published evidence of adequate absorption via jejunal feeding tube in the nonfasted state, it would seem prudent to ensure that patients are fasted when rifampin is administered via PEJ tube, just as patients are when oral rifampin is administered. This report represents the first documented evidence, to our knowledge, of adequate rifampin absorption when administered via PEJ tube and provides important reassurance for health care providers, patients, and families facing similar clinical scenarios.
ISSN:0277-0008
1875-9114
DOI:10.1002/phar.1730