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Rifafour (Myambutol)

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Rifafour (generic name: ethambutol; brand names include: EMB / Etibi / Combutol / Mycobutol / Tibitol / Servambutol / Tibinil) belongs to a group of medicines called antitubercular agents. Rifafour is used for the treatment of pulmonary tuberculosis, usually in combination with other antituberculosis medicines.

Other names for this medication:
Combutol, Etambutol, Ethambutol, Myambutol, Rimstar

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Also known as:  Myambutol.


Rifafour is a prescription medication used for the treatment of pulmonary tuberculosis. It is usually given in combination with other tuberculosis drugs, such as isoniazid, rifampicin and pyrazinamide.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.


Initial Treatment: In patients who have not received previous antituberculous therapy, administer Rifafour 15 mg/kg (7 mg/ lb) of body weight, as a single oral dose once every 24 hours. In the more recent studies, isoniazid has been administered concurrently in a single, daily, oral dose.

Retreatment: In patients who have received previous antituberculous therapy, administer Rifafour 25 mg/kg (11 mg/lb) of body weight, as a single oral dose once every 24 hours. Concurrently administer at least one other antituberculous drug to which the organisms have been demonstrated to be susceptible by appropriate in-vitro tests. Suitable drugs usually consist of those not previously used in the treatment of the patient. After 60 days of Rifafour administration, decrease the dose to 15 mg/kg (7mg/ lb) of body weight, and administer as a single oral dose once every 24 hours.

During the period when a patient is on a daily dose of 25 mg/kg, monthly eye examinations are advised.


If you take too much Rifafour, call your local Poison Control Center or seek emergency medical attention right away.


Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F) away from moisture and heat. Throw away any unused medicine after the expiration date. Keep out of the reach of children.

Side effects

The most common side effects associated with Rifafour are:

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Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.


Rifafour may cause dizziness. This effect may be worse if you take it with alcohol or certain medicines. Use Rifafour with caution. Do not drive, operate machinery, or perform other possibly unsafe tasks until you know how you react to it.

Rifafour only works against bacteria; it does not treat viral infections (eg, the common cold).

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HIV patients with TB have significantly better survival if they receive HAART during anti-tuberculosis treatment. Efavirenz-based HAART is associated with fewer AEs than protease inhibitor-based HAART.

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The effectiveness of a DOTS programme with first-line therapy fell short of the 85% target set by WHO. First-line therapy may not be sufficient in settings with a high degree of resistance to antibiotics.

rifafour drug reactions

Cystic fibrosis (CF) patients require higher dosages of many antibiotics. The relapse of tuberculosis in one CF patient, and the repeated growth of Mycobacterium avium-intracellulare in another, despite conventional therapy, raised the question of whether the serum levels of the antimycobacterial drugs were adequate. Antimycobacterial drug serum concentrations were assayed in 10 CF patients with pulmonary mycobacterial disease. Serum levels below the proposed target range were seen 2 h after drug intake in the initial four patients treated: for rifampicin in 2/3, ethambutol in 3/4 and for clarithromycin in 2/3 patients, despite standard dosages. Reassays after dose adjustment and assays in six other patients showed that adequate levels were not achieved 4 h after clarithromycin in 3/5, ethambutol in 1/5, ciproflaxacin in 1/2 and ofloxacin in 2/2 patients. The patient with relapse of tuberculosis and the patient with continuous growth of M. avium-intracellulare improved and became culture negative after dose adjustment. Low drug serum levels is one reason for therapy failure in cystic fibrosis patients with mycobacterial disease. Therapeutic drug monitoring is recommended.

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In both groups, local symptoms of all patients were relieved significantly 1-3 weeks postoperatively. And 10/14 cases (71%) in Group A and 14/19 cases (74%) in Group B with neurological deficits had excellent or good clinical outcomes (P > 0.05). The levels of erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.4 mm/h preoperatively to normal at 8-12 weeks postoperatively. Kyphosis degrees were corrected by a mean of 11.5° in Group A and 12.6° in Group B (P < 0.01). The correction loss was 6.8° in Group A and 6.1° in Group B at the last follow-up (P < 0.01). Fusion rates of the grafting bone were 92.5% and 91.8% respectively at the final follow-up (P > 0.05). Severe complications did not occur.

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Results show that Ethambutol alters synaptic connections between horizontal cells and cones in a dose-related fashion; Ethambutol treatment can be toxic for cone pedicles and can cause their degeneration; and the rod pathway is not affected by the drug. This indicates that Ethambutol influences the color-coding process already at the level of the cone-horizontal cell synapse.

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We conducted a prospective, observational pharmacokinetic study in children 10 years old or younger who were on isoniazid, rifampicin, pyrazinamide and ethambutol therapy in Durban, KwaZulu-Natal, South Africa. Blood was collected at six timepoints over a 24 h period, chosen using optimal sampling theory. The drug concentrations were simultaneously modelled to identify the compartmental pharmacokinetics of each drug in each child, using the ADAPT program.

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For high-risk population of active TB, glucocorticoid therapy plus 1 or 2 preventive anti-TB treatment drugs may prevent its occurrence. And there is no serious adverse reaction during preventive anti-TB treatment.

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Drug susceptibility of 208 MDR isolates revealed that 132 (63.46%) were resistant to streptomycin (SM), 96 (46.15%) to ethambutol (EMB), 51 (24.52%) to ofloxacin (OFLX), and 26 (12.50%) to kanamycin (KAN); six (2.88%) isolates had XDR profiles. In comparison with the drug susceptibility phenotype, the sensitivity of drug resistance by DNA sequencing was 91.83% for RIF, 87.50% for INH, 66.67% for EMB, 74.51% for OFLX and 53.85% for KAN resistance. 12.50% of EMB- and 1.27% of OFLX-susceptible isolates were harboured genetic mutations in embB and gyrA, respectively.

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rifafour dosage adults 2016-08-06

Combination therapy with 4HR in the continuation phase dominates 6HE as it is associated Unixime 400 Mg Posologia with both lower expected costs and lower expected mortality. These data support the WHO recommendation to transition to a continuation phase comprising 4HR.

rifafour tablets side effects 2015-01-19

Comprehensive information on the effects of cytochrome P450 2B6 (CYP2B6) polymorphisms, clinical factors, and drug-drug interactions on efavirenz concentrations in HIV/tuberculosis-coinfected (HIV/TB) patients is unavailable. A total of 139 HIV/TB adults, 101 of whom received a rifampin-containing anti-TB regimen, were prospectively enrolled to receive efavirenz (600 mg)/tenofovir/lamivudine. Nine single nucleotide polymorphisms (SNPs) within CYP2B6 were genotyped. Plasma efavirenz concentrations were measured at 12 weeks. The median (interquartile range [IQR]) efavirenz concentration was 2.3 (1.4 to 3.9) mg/liter. The SNPs (frequencies of heterozygous and homozygous mutants) were 64C>T (10% and 1%), 499C>G (0% and 0%), 516G>T (47% and 8%), 785A>G (54% and 10%), 1375A>G (0% and 0%), 1459C>T (3% and 0%), 3003C>T (44% and 27%), 18492T>C (39% and 6%), and 21563C>T (57% and 5%). The four most frequent CYP2B6 haplotypes identified were *1/*6 (41%), *1/*1 (35%), *1/*2 (7%), and *6/*6 (7%). The heterozygous/homozygous mutation associated with low efavirenz concentrations was 18492T>C (P < 0.001), and those associated with high efavirenz concentrations were 516G>T, 785A>G, and 21563C>T (all P < 0 Antirobe 75 Mg Prix .05). Haplotype *1/*1 was associated with low efavirenz concentrations, and *6/*6, *1/*6, and *5/6 were associated with high efavirenz concentrations. As shown by multivariate analysis, low efavirenz concentrations were significantly associated with the *1/*1 haplotype (beta = -1.084, P = 0.027) and high body weight (beta = -0.076, P = 0.002). In conclusion, pharmacogenetic markers of CYP2B6 have the greatest impact with respect to inducing low plasma efavirenz concentrations in HIV/TB Thai patients.

is rifafour an antibiotic 2015-01-09

Evidences of spinal tuberculosis have been found in Egyptian mummies and the disease is one of the oldest diseases afflicting humans. The demography, diagnosis, medical and surgical treatment, as advocated currently, have been reviewed with a brief discussion of the literature. Early diagnosis Amoxil Brand Name and comprehensive treatment are needed to control this public health problem.

rifafour drug reactions 2017-05-29

A 20-year-old female was checked by chest X-ray film just before Amoxicillin Dosage For Children starting practical nurse training in the hospital. She was diagnosed as tuberculosis in the initial phase of treatment. In Japan, the number of newly registered tuberculosis has been increasing since 1997, and the stop-tuberculosis campaign is organized by the Ministry of Health and Welfare. The incidence rate of tuberculosis announced officially by the Ministry of Public Welfare was 33.9 per 100,000 in 1997, while that of nontuberculous mycobacteriosis has been increasing year by year, and it was 2.45 in 1997. The one out of 4 nontuberculous mycobacteriosis is caused by M. kansasii. Six colonies of Mycobacterium kansasii were detected by gastric juice culture from this patient. Untreated strains of M. kansasii are susceptible to rifampicin, isoniazid, ethambutol, ethionamide, streptomycin and cycloserine at concentrations readily available in the serum with usual therapeutic doses. Isolates are usually resistant to available serum level of pyrazinamide. The patient was treated with rifampicin, isoniazid and ethambutol for 6 months. Pyrazinamide was stopped at 1 month and 10 days treatment due to liver dysfunction and resistance to the organism. Pulmonary infiltration with cavity disappeared during follow-up examination. Nowadays we must take into account not only tuberculosis but also primary nontuberculous mycobacteriosis at regular medical check of young female.

rifafour pills 2017-05-14

Twenty-one-month-old girl with MDR-TB Clamoxin 400 Mg meningitis.

rifafour medicine 2015-06-14

He was treated with Trichazole Tablet minocycline, clarithromycin, and ethambutol. In addition, he underwent radical synovectomy of the lesion.

rifafour generic name 2015-06-15

We conducted a randomized, double-blind, placebo-controlled, phase 3 trial to test the Ciproxina Xr 500 Mg noninferiority of two moxifloxacin-containing regimens as compared with a control regimen. One group of patients received isoniazid, rifampin, pyrazinamide, and ethambutol for 8 weeks, followed by 18 weeks of isoniazid and rifampin (control group). In the second group, we replaced ethambutol with moxifloxacin for 17 weeks, followed by 9 weeks of placebo (isoniazid group), and in the third group, we replaced isoniazid with moxifloxacin for 17 weeks, followed by 9 weeks of placebo (ethambutol group). The primary end point was treatment failure or relapse within 18 months after randomization.

rifafour dosage weight 2016-03-10

Multidrug resistance is a problem in the management of tuberculosis, creating an urgent need for new regimens including currently available drugs. Macrophage models allow an evaluation of the effect of drugs against intracellular bacilli. The effect of the following different drug combinations against six multidrug-resistant and six drug-susceptible clinical isolates of Mycobacterium tuberculosis multiplying inside the human macrophage THP-1 cell line was studied: levofloxacin/linezolid/ethambutol; levofloxacin/amikacin/ethambutol; and levofloxacin/linezolid/amikacin. Macrophages were lysed, seeded onto Middlebrook 7H11 plates and Eltocin Syrup Used For CFU were counted after 21 days of incubation. The interaction of the drugs in combination was interpreted by the effect of the combination compared with the most active single drug alone. The antimicrobial activity of the drugs was evaluated comparing the log(10)CFU/well of the isolate with and without the drug. Drug concentrations within infected macrophages and in extracellular medium were simultaneously determined by chromatography. The levofloxacin/linezolid/amikacin and levofloxacin/linezolid/ethambutol combinations showed antagonism against most of the isolates (91.7%) after a 4-day protocol, whereas levofloxacin/amikacin/ethambutol displayed indifference. Levofloxacin alone and levofloxacin/amikacin/ethambutol were the most potent antimicrobials, presenting reductions up to 5.49 log(10) and 5.86 log(10), respectively. The drug penetration percentages ranged from 5.46% to 11.10%. Intracellular concentrations for the drug alone compared with those for the drugs in combination were not significantly different. All of the combinations tested against M. tuberculosis-infected macrophages showed antimicrobial activity, with combinations including linezolid and levofloxacin showing an antagonistic effect that may be explained by efflux transporters or changes in the macrophage environment.

rifafour tablets for tb 2015-03-01

Department of Microbiology Cephalexin Pill 802 , Armed Forces Institute of Pathology, Rawalpindi.

rifafour medication 2016-12-09

Fifty-four HCV-seropositive patients with newly diagnosed active TB who were treated with isoniazid, rifampin, ethambutol, and/or pyrazinamide were included in Trimol Syrup For Babies the study population. Ninety-seven HCV-seronegative patients were selected as control subjects.

rifafour tablets 2015-11-02

Inpatient service Milixim Dry Syrup and tuberculosis (TB) clinic of a public hospital.

rifafour renal dose 2015-04-05

Human tuberculosis is caused by members of the Mycobacterium tuberculosis complex, which includes M. tuberculosis, M. bovis, M. africanum and M. bovis BCG. However there are increasing reports of rarely occurring genetic variants such as M. canettii, M. microti and M. pinipedii. The natural reservoir, mode of transmission and potential modification of host interaction of these species is not yet fully elucidated. We report a rare case of extensive cavitary smear-positive tuberculosis of the left lung caused by M. microti in an immunocompetent tuberculin-negative 68-year-old man. Transmission by a raccoon dog or raccoon as a novel M. microti reservoir was suspected. Spoligotyping of the isolate revealed the llama subtype. The strain exhibited no detectable drug resistance. Response to standard tuberculosis treatment, initially comprising isoniacid, rifampicin, pyrazinamide and ethambutol, was excellent. Delayed growth on solid media, specific phenotypic features and contact with animals should raise suspicion for this rare mycobacterial infection.