Situation
On December 22, 2021, the The FDA announced a temporary national shortage of rifampicin oral capsules due to product discontinuation, equipment malfunction and shortage of an active ingredient.
Since then, LAC DPH has continued to increase the local supply of rifampicin oral capsules by accessing the National Stockpile of Tuberculosis Emergency Drugs. Nevertheless, as of mid-January 2022, several local pharmacies in Los Angeles County reported issues with the timely supply of oral rifampin capsules for the treatment of patients with both active tuberculosis and ITL. . LAC DPH anticipates that the current shortage of rifampin oral capsules may continue to affect local healthcare providers and pharmacies through April 2022.
The current shortage of oral rifampin capsules is compounded by continued national shortages of lyophilized rifampicin powder for intravenous injection and rifapentine oral tablets.
The role of rifampicin in the control and elimination of tuberculosis
Pulmonary tuberculosis is an airborne disease and rifampicin is the cornerstone of modern multidrug treatment regimens for active tuberculosis. Rifampicin-containing regimens shorten the total duration of treatment, improve TB-free survival, and decrease infectiousness in patients with active TB.
Rifampicin is also part of two short-term preventive treatment regimens: 4 months of daily rifampin (4R) and 3 months of isoniazid plus rifampin (3HR). The efficacy of treatment for ITL in preventing progression to active tuberculosis is ≥ 90%. Due to improved real-world completion rates, equivalent efficacy, and favorable tolerability, short-course rifamycin-based regimens are preferred over conventional isoniazid monotherapy.
Temporary or ongoing drug shortages alone should not be considered justifications for postponing, interrupting, or otherwise compromising the effectiveness of treatment for patients with active TB and LTBI.
