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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/12/02 10:35:09」(JST)

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Rifabutin (Rfb) is a bactericidal antibiotic drug primarily used in the treatment of tuberculosis. The drug is a semi-synthetic derivative of rifamycin S. Its effect is based on blocking the DNA-dependent RNA-polymerase of the bacteria. It is effective against Gram-positive and some Gram-negative bacteria, but also against the highly resistant mycobacteria, e.g. Mycobacterium tuberculosis, M. leprae, and M. avium intracellulare.

Rifabutin is on the World Health Organization's List of Essential Medicines, the most important medications needed in a basic health system.^[1]

Medical uses

Rifabutin is now recommended as first-line treatment for tuberculosis,^[2] but rifampicin is more widely used because of its cheaper cost.

Rifabutin is used in the treatment of Mycobacterium avium complex disease, a bacterial infection most commonly encountered in late-stage AIDS patients. Its main usefulness lies in the fact that it has lesser drug interactions than rifampicin; therefore HIV infected patients on HAART are usually given rifabutin for treatment of TB.

Rifabutin is well tolerated in patients with HIV-related tuberculosis (TB), but new findings suggest that patients with low CD₄ cell counts have a high risk of treatment failure or relapse due to acquired rifamycin resistance. Since patients co-infected with TB and HIV/AIDS are likely to get TB treated first, when the CD₄ is suppressed at the time TB treatment begins, doctors and patients should be aware of a possible rifamycin resistance.

Rifabutin is also being investigated in trials for treating Crohn's disease as part of the anti-MAP therapy. In a Phase III study administering sub-therapeutic doses of rifabutin in combination therapy to patients not identified with MAP infections, it was associated with significant short term benefits.^[3]^[4]

It has also found to be useful in the treatment of Chlamydophila pneumoniae (Cpn) infection.

History

Scientists at the Italian drug company Achifar discovered rifabutin in 1975. (Eventually Archifar became part of Farmitalia Carlo Erba, a unit of the conglomerate Montedison which was subsequently bought by Pharmacia) This company's Adria Laboratories subsidiary filed for Food and Drug Administration (FDA) approval of rifabutin under the brand name Mycobutin in the early 1990s and the drug gained FDA approval in December 1992.

Rifabutin is primarily bactericidal antibiotic drug used to treat tuberculosis. Its effect on bacteria is based on the DNA-dependent RNA polymerase blocking drug rifamycin S, a semi-synthetic derivative. It is effective, for example, in highly resistant mycobacteria, Gram-positive bacteria (and some are effective against Gram-negative bacteria), but also against Mycobacterium tuberculosis, M. leprae, and M. avium intracellulare.

References

^ "WHO Model List of EssentialMedicines" (PDF). World Health Organization. October 2013. Retrieved 22 April 2014.
^ Guidelines for the programmatic management of drug-resistant tuberculosis: emergency update 2008 (WHO/HTM/TB/2008.402). Geneva, Switzerland: World Health Organization. 2008. p. ix. ISBN 978-92-4-154758-1.
^ "Two-year combination antibiotic therapy with clarithromycin, rifabutin, and clofazimine for Crohn's disease". Gastroenterology. 132 (7): 2313–9. June 2007. doi:10.1053/j.gastro.2007.03.031. PMID 17570206.
^ Kuenstner, J. Todd (2007). "The Australian Antibiotic Trial in Crohn's Disease: Alternative Conclusions From the Same Study". Gastroenerology. 133 (5): 1742–1743. doi:10.1053/j.gastro.2007.09.012.

UpToDate Contents

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1. リファマイシン（リファンピン、リファブチン、リファペンチン） rifamycins rifampin rifabutin rifapentine
2. Treatment of pulmonary tuberculosis in HIV-infected adults
3. HIV陰性患者における肺非結核性抗酸菌感染症の治療 treatment of nontuberculous mycobacterial infections of the lung in hiv negative patients
4. HIV感染患者におけるMycobacterium avium complex (MAC）感染症 mycobacterium avium complex mac infections in hiv infected patients
5. 小児における播種性非結核性抗酸菌（NTM）感染症およびNTM菌血症の概要 overview of disseminated nontuberculous mycobacterial ntm infections and ntm bacteremia in children

English Journal

In vitro antimicrobial susceptibility of Helicobacter pylori to nine antibiotics currently used in Central Italy.

Di Giulio M1, Di Campli E1, Di Bartolomeo S1, Cataldi V1, Marzio L2, Grossi L2, Ciccaglione AF2, Nostro A3, Cellini L1.
Scandinavian journal of gastroenterology.Scand J Gastroenterol.2016 Mar;51(3):263-9. doi: 10.3109/00365521.2015.1092577. Epub 2015 Oct 7.
OBJECTIVE: Helicobacter pylori expresses an increased resistance in respect to antimicrobials currently used in therapy. The aim of this study was to evaluate the antimicrobial profiles of H. pylori isolates to nine conventional antibiotics used in a Central Region (Abruzzo) of Italy.MATERIALS AND M
PMID 26554617

What Dose Of Rifabutin Is Recommended With Antiretroviral Therapy?

Yapa HM1, Boffito M, Pozniak A.
Journal of acquired immune deficiency syndromes (1999).J Acquir Immune Defic Syndr.2016 Feb 5. [Epub ahead of print]
Since the advent of combination antiretroviral therapy to successfully treat HIV infection, drug-drug interactions (DDIs) have become a significant problem as many antiretrovirals (ARVs) are metabolised in the liver. Antituberculous therapy traditionally includes rifamycins, particularly rifampicin
PMID 26855245

Population pharmacokinetic drug-drug interaction pooled analysis of existing data for rifabutin and HIV PIs.

Hennig S1, Svensson EM2, Niebecker R2, Fourie PB3, Weiner MH4, Bonora S5, Peloquin CA6, Gallicano K7, Flexner C8, Pym A9, Vis P10, Olliaro PL11, McIlleron H12, Karlsson MO2.
The Journal of antimicrobial chemotherapy.J Antimicrob Chemother.2016 Jan 31. pii: dkv470. [Epub ahead of print]
OBJECTIVES: Extensive but fragmented data from existing studies were used to describe the drug-drug interaction between rifabutin and HIV PIs and predict doses achieving recommended therapeutic exposure for rifabutin in patients with HIV-associated TB, with concurrently administered PIs.METHODS: Ind
PMID 26832753

Japanese Journal

Macrocyclic Compounds from Ansamycin Antibiotic Class as Inhibitors of PD1–PDL1 Protein–Protein Interaction

Patil Sachin P.,Yoon Suk-Chung,Aradhya Abhay G.,Hofer Jeremy,Fink Madison A.,Enley Erika S.,Fisher James E.,Herb Marie C.,Klingos Anthony,Proulx James T.,Fedorky Megan T.
ＣＨＥＭＩＣＡＬ　＆　ＰＨＡＲＭＡＣＥＵＴＩＣＡＬ　ＢＵＬＬＥＴＩＮ 66(8), 773-778, 2018
… Importantly, one of these macrocyclic antibiotics, Rifabutin, showed an IC50 …
NAID 130007428974

肺MAC症治療薬によるゲフィチニブ血中濃度の変動を測定しつつ治療した肺癌の1例

伊藤浩,中根茂喜,中村さや,神山潤二,町田和彦,松尾正樹
肺癌 56(5), 355-360, 2016
背景．肺癌および非結核性肺抗酸菌症（肺NTM症）は増加傾向で，両疾患の合併例の増加も見込まれる．両疾患の治療薬には薬物相互作用が知られている．肺癌治療Gefitinibの血中濃度はCYP3A4誘導剤のリファンピシンやリファブチン（RBT）で低下，CYP3A4阻害薬のクラリスロマイシン（CAM）で上昇し得るため注意を要する．症 …
NAID 130005279055

臨床報告リファブチン関連ぶどう膜炎にエタンブトール視神経症を併発した1例

和田剛成,木ノ内玲子,吉田晃敏
眼科 57(8), 1059-1064, 2015-07
NAID 40020540508

Related Pictures

Rifabutin Side Effects in Detail - Drugs.com Mycobacterium Leprae Images, Stock Photos & Vectors | Shutterstock Rifabutin - brand name list from Drugs.com Rifabutin - FDA prescribing information, side effects and uses 臺北榮民總醫院藥物外觀辨識系統 Rifabutin | Working Group for New TB Drugs NanJieCun Pharmaceutical Group TB Online - Rifabutin

★リンクテーブル★

リンク元	「リファブチン」「リファマイシン」「ansamycin」

「リファブチン」

Rifabutin
Clinical data
Trade names	Mycobutin
AHFS/Drugs.com	Monograph
MedlinePlus	a693009
Pregnancy; category	AU: C; US: B (No risk in non-human studies); ;
Routes of; administration	Oral (capsules)
ATC code	J04AB04 (WHO)
Legal status
Legal status	UK: POM (Prescription only); US: ℞-only;
Pharmacokinetic data
Bioavailability	85%
Protein binding	85%
Metabolism	Hepatic
Biological half-life	28 to 62 hours (mean)
Excretion	Renal and fecal
Identifiers
	Systematic (IUPAC) name: (9S,12E,14S,15R,16S,17R,18R,19R,20S,; 21S,22E,24Z)-6,16,18,20-tetrahydroxy-1'-; isobutyl-14-methoxy-7,9,15,17,19,21,25-; hepta-methyl-spiro[9,4-(epoxypentadeca; [1,11,13]trienimino)-2H-furo-[2',3':7,8]-naphth; [1,2-d]imidazol-2,4'-piperidin]-5,10,26-(3H,9H)-; trione-16-acetate
CAS Number	72559-06-9
PubChem (CID)	6323490
DrugBank	DB00615
ChemSpider	10482168
UNII	1W306TDA6S
KEGG	D00424
ChEBI	CHEBI:45367
ChEMBL	CHEMBL444633
Chemical and physical data
Formula	C46H62N4O11
Molar mass	847.005 g/mol
3D model (Jmol)	Interactive image
	SMILES CC(C)CN1CCC2(CC1)/N=C\3/c4c6C(=O)[C@@]5(C)O/C=C/[C@H](OC)[C@@H](C)[C@@H](OC(C)=O)[C@H](C)[C@H](O)[C@H](C)[C@@H](O)[C@@H](C)\C=C\C=C(\C)C(=O)N\C(=C/3/N2)C(=O)c4c(O)c(C)c6O5 ;
	InChI InChI=1S/C46H62N4O11/c1-22(2)21-50-18-16-46(17-19-50)48-34-31-32-39(54)28(8)42-33(31)43(56)45(10,61-42)59-20-15-30(58-11)25(5)41(60-29(9)51)27(7)38(53)26(6)37(52)23(3)13-12-14-24(4)44(57)47-36(40(32)55)35(34)49-46/h12-15,20,22-23,25-27,30,37-38,41,49,52-54H,16-19,21H2,1-11H3,(H,47,57)/b13-12+,20-15+,24-14-/t23-,25+,26+,27+,30-,37-,38+,41+,45-/m0/s1 ; Key:ATEBXHFBFRCZMA-VXTBVIBXSA-N ;
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