리팜핀
Rifampin
Rifampicin (semi-synthetic zwitterion derivative of rifamycin B)
다른 이름: Rifadin · Rimactane · Ba-41166/E · L-5103 · NSC-113926 · rifaldazine · rifampicinum · rifamycin AMP · Rifampin
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Combination therapy of atypical Mycobacteria infections; treatment of resistant Staph endocarditis | 10-20 mg/kg PO q8-12h | PO | q8-12h | — | 🌎 NA |
| Alternate treatment for scarred pyogranulomatous pyoderma | 5-10 mg/kg PO q24h | PO | q24h | 4-8 weeks | 🌎 NA |
| Actinomycosis | 10-20 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Susceptible infections (e.g., mycobacteriosis, resistant staphylococcal pyoderma, ehrlichiosis) | 10-15 mg/kg | PO | q24h | Duration depends on the specific infection being treated | 🌍 EU |
- Combination therapy of atypical Mycobacteria infections; treatment of resistant Staph endocarditis: In combination with amoxicillin/clavulanate or trimethoprim/sulfa
- Alternate treatment for scarred pyogranulomatous pyoderma: Must be used with another antibiotic to reduce risk for resistance development (e.g., cephalexin or a potentiated sulfonamide). Monitor CBC, liver screens, and UA every 2 to 3 weeks.
- Susceptible infections (e.g., mycobacteriosis, resistant staphylococcal pyoderma, ehrlichiosis): Must be used in combination with other antimicrobial drugs to prevent the emergence of resistant organisms.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Susceptible infections (e.g., mycobacteriosis, Rhodococcus equi, chlamydiosis, bartonellosis) | 10-15 mg/kg | PO | q24h | Duration depends on the specific infection being treated | 🌍 EU |
- Susceptible infections (e.g., mycobacteriosis, Rhodococcus equi, chlamydiosis, bartonellosis): Must be used in combination with other antimicrobial drugs to prevent the emergence of resistant organisms.
새
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Treatment of mycobacteriosis | 45 mg/kg PO once daily | PO | q24h | — | 🌎 NA |
- Treatment of mycobacteriosis: In combination with ethambutol (30 mg/kg PO once daily) and one of the following: clofazimine (6 mg/kg PO once daily) or isoniazid (30 mg/kg PO once daily).
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Treatment of Rhodococcus equi (C. equi) infections in foals | 5 mg/kg PO two times daily | PO | q12h | — | 🌎 NA |
| Treatment of Rhodococcus equi (C. equi) infections in foals | 5 mg/kg PO two times daily or 10 mg/kg PO once daily | PO | q12h or q24h | 4-9 weeks | 🌎 NA |
| Treatment of proliferative enteropathy caused by Lawsonia intracellularis in foals | 10 mg/kg PO once daily | PO | q24h | minimum of 21 days | 🌎 NA |
- Treatment of Rhodococcus equi (C. equi) infections in foals: With erythromycin 15-25 mg/kg, PO q12-24h. Clarithromycin may be superior due to erythromycin side effects.
- Treatment of Rhodococcus equi (C. equi) infections in foals: With erythromycin 25 mg/kg, PO q6-8h.
- Treatment of proliferative enteropathy caused by Lawsonia intracellularis in foals: In combination with erythromycin estolate (25 mg/kg PO q6-8h)
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
리팜핀은 리파마이신계에 속하는 지용성이 매우 높은 반합성 항균제입니다. 수의학에서 심부 세포내 감염, 특히 망아지의 로도코커스 에퀴(Rhodococcus equi) 감염 치료에 핵심적인 역할을 합니다.
건락성 물질, 뼈, 농양 및 대식세포에 침투하는 탁월한 능력이 있어 마이코박테리움, 황색포도상구균, 로소니아 인트라셀룰라리스와 같은 세포내 병원체에 매우 효과적입니다. 고농도에서는 약간의 항진균 및 항바이러스 활성도 나타냅니다.
임상 요점: 리팜핀은 절대 단독 요법으로 사용해서는 안 됩니다. 세균은 단일 단계 돌연변이를 통해 빠르게 내성을 발달시킬 수 있습니다. 항상 다른 항균제(예: 말의 경우 에리트로마이신이나 클래리트로마이신 같은 마크로라이드계, 개는 세팔로스포린이나 설파제)와 병용하여 처방해야 합니다.
작용 기전
Rifampin can be bactericidal or bacteriostatic depending on the concentration and the susceptibility of the target organism.
- Target: It binds strongly to the beta subunit of bacterial DNA-dependent RNA polymerase.
- Pathway: Binding inhibits the enzyme → suppresses the initiation of chain formation for RNA synthesis → halts bacterial protein production → cell death.
- Selectivity: Rifampin is highly selective for bacterial enzymes and does not inhibit mammalian RNA polymerase, providing a wide margin of safety for the host.
안전성·주의사항
금기사항
- Hypersensitivity to rifampin or other rifamycins
- Use with extreme caution in patients with preexisting hepatic dysfunction
- Pregnancy (teratogenic at high doses)
- Pre-existing liver disease or hepatic dysfunction
부작용
- Red-orange discoloration of bodily fluids (urine, tears, sweat, saliva)
- Gastrointestinal distress (anorexia, vomiting, diarrhea)
- Elevated liver enzymes and potential hepatotoxicity
- Rashes and erythema (noted in cats and humans)
- In horses (especially with macrolides): mild diarrhea to severe enterocolitis, hyperthermia, and acute respiratory distress
- Intravenous use in horses (rare): CNS depression, sweating, hemolysis, anorexia
- Elevated serum hepatic enzymes
- Clinical hepatitis
- Orange-red discoloration of urine, saliva, tears, and feces
- Gastrointestinal upset (anorexia, vomiting, diarrhea)
주의
Use with caution in patients with preexisting hepatic dysfunction; dosage reduction may be necessary. Never use as a monotherapy due to the rapid development of bacterial resistance. Rifampin is a potent inducer of hepatic microsomal enzymes, which can significantly alter the metabolism of concurrently administered drugs. It is excreted in maternal milk; use with caution in nursing veterinary patients. May cause false-positive BSP (bromosulfophthalein) test results and interfere with microbiologic assays of serum folate and vitamin B12.
약물 상호작용
In vitro antagonism has been reported; concurrent use should be avoided.
Decreased serum levels and shortened half-life due to hepatic microsomal enzyme induction by rifampin.
Decreased serum levels and shortened half-life due to hepatic enzyme induction.
Decreased serum levels and shortened half-life due to hepatic enzyme induction.
Decreased serum levels and shortened half-life due to hepatic enzyme induction.
Decreased serum levels and shortened half-life due to hepatic enzyme induction.
Decreased serum levels and shortened half-life due to hepatic enzyme induction.
Decreased serum levels and shortened half-life due to hepatic enzyme induction.
Decreased serum levels and shortened half-life due to hepatic enzyme induction.
Decreased serum levels and shortened half-life due to hepatic enzyme induction.
Increased rate of metabolism of theophylline due to hepatic enzyme induction.
Increased rate of metabolism of itraconazole due to hepatic enzyme induction, leading to subtherapeutic antifungal levels.
모니터링
- Clinical efficacy and resolution of infection
- Liver function tests (especially with long-term therapy)
- Chest radiographs and plasma fibrinogen levels (prognostic indicators for C. equi infections in foals after 1 week of therapy)
- Baseline and periodic serum hepatic enzyme levels (ALT, AST, ALP, Bilirubin)
- Clinical signs of hepatitis (icterus, anorexia, vomiting, lethargy)
약동학
반감기
흡수
Relatively well absorbed from the GI tract. Oral bioavailability is about 40-70% in horses and 37% in adult sheep. Concurrent food administration may delay and slightly reduce peak plasma levels.
분포
Very lipophilic. Readily penetrates most body tissues (including bone and prostate), cells, and fluids (including CSF). Uniquely penetrates abscesses and caseous material. 70-90% bound to serum proteins. Distributes into milk and crosses the placenta. Volume of distribution is ~0.9 L/kg in horses and 1.3 L/kg in sheep.
대사
Metabolized in the liver to a deacetylated form that retains antibacterial activity. Rifampin induces hepatic microsomal enzymes, meaning elimination rates may increase over time with repeated dosing (auto-induction).
배설
Both the active metabolite and unchanged drug are excreted primarily in the bile, but up to 30% may be excreted in the urine. The parent drug undergoes substantial enterohepatic recirculation, but the metabolite does not.
과다투여
Clinical signs of oral rifampin overdose are generally extensions of its adverse effects, including gastrointestinal distress, orange-red coloring of fluids, and skin erythema (noted particularly in cats).
Massive overdoses carry a significant risk of hepatotoxicity. Dogs may exhibit central nervous system depression.
Treatment:
- Empty the gut following standard decontamination protocols for massive oral overdosage.
- Monitor liver enzymes closely.
- Initiate supportive treatment as necessary.
제품
제형
- Oral capsules
- Lyophilized powder for injection
- 150 mg capsule
- 300 mg capsule
- 20 mg/ml syrup
인용의약품
- Rifampin Oral Capsules: 150 mg & 300 mg (Rifadin®, Rimactane®, generic)
- Rifampin Lyophilized Powder for Injection Solution: 600 mg (Rifadin®, generic)
- Rifadin 150 mg capsules
- Rifadin 300 mg capsules
- Rifadin 20 mg/ml syrup
- Rimactane capsules
규제 현황
Human authorized products used under the prescribing cascade. Rifamycins are critically important antimicrobials.
POM (Prescription Only Medicine). Used under the cascade.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Rifampin capsules should be stored in tight, light-resistant containers, preferably at room temperature (15-30°C).
보호자 정보
- 무해한 변색: 이 약은 반려동물의 소변, 눈물, 땀, 침을 붉은 오렌지색으로 변하게 할 수 있습니다. 이는 완전히 정상적이고 무해하지만, 직물, 카펫 또는 밝은 색의 털에 영구적인 얼룩을 남길 수 있으니 주의하세요.
- 투여 방법: 흡수율을 높이려면 이 약을 공복에 투여하세요. 위장 장애를 일으키는 경우 소량의 간식과 함께 줄 수 있습니다.
- 병용 요법: 리팜핀은 거의 항상 다른 항생제와 함께 처방됩니다. 두 약물을 지시대로 정확히 투여하고 전체 치료 과정을 마치는 것이 매우 중요합니다. 세균이 리팜핀에 빠르게 내성을 가질 수 있으므로 절대 일찍 중단하지 마세요.
- 주의 사항: 심한 설사, 식욕 부진, 극심한 무기력증 또는 눈/잇몸이 노랗게 변하는 증상(황달)이 관찰되면 간에 무리가 가고 있다는 신호일 수 있으므로 수의사에게 연락하세요.
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