Rifamycin antimycobacterial
Rifabutin
Brand names: Mycobutin
Adult dose
Dose: MAC prophylaxis: 300mg PO OD. TB (alternative to rifampicin in HIV): 150–450mg PO OD per regimen
Route: PO
Frequency: OD
Clinical pearls
- MAC prophylaxis/treatment in HIV; TB in patients on protease inhibitors
- Less enzyme induction than rifampicin → preferred with HIV PIs
Contraindications
- Severe hepatic impairment
- Hypersensitivity to rifamycins
Side effects
- Uveitis (dose-related)
- Orange discolouration of body fluids
- Hepatotoxicity
- Cytopenias
- GI upset
- Flu-like syndrome
Interactions
- Strong enzyme inducer (CYP3A4 — less than rifampicin)
- Many antiretrovirals
- Hormonal contraceptives
- Warfarin
Monitoring
- LFTs
- FBC
- Eye exam if uveitis
Reference: BNF; NICE NG33; BHIVA; https://bnf.nice.org.uk/drugs/rifabutin/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023