USE OF RIFAMPICIN IN PREGNANCY

Rifampicin is a semisynthetic antibacterial drug used in the treatment of tuberculosis, leprosy, brucellosis, Legionnaire’s disease, Haemophilus influenza, and serious staphylococcal infections. Rifampicin is also used as prophylaxis against meningococcal meningitis, and off-license for pruritis caused by intrahepatic cholestasis of pregnancy.

There are very limited data relating to fetal risks following exposure to rifampicin during pregnancy. No increased risks of miscarriage, congenital malformation, preterm delivery or low birth weight have been attributed to rifampicin exposure, although the underlying maternal infections requiring rifampicin treatment have known independent risks during pregnancy.

Neonatal haemorrhage has been reported following exposure to rifampicin in late pregnancy; therefore, both maternal supplementation with vitamin K and neonatal intramuscular vitamin K at birth is recommended when rifampicin is administered in the weeks preceding delivery.

Due to the increased risk to both mother and fetus of an untreated maternal illness, if clinically indicated, rifampicin should not be withheld in pregnancy. Exposure to rifampicin at any stage of pregnancy would not usually be regarded as medical grounds for termination of pregnancy. Other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.