Letters to the Editor Evaluation of High- versus Standard-Dose Rifampin in Indonesian Patients with Pulmonary Tuberculosis

We previously found peak plasma concentrations of ri-fampin below 4 mg/liter in 70 % of Indonesian tuberculosis (TB) patients treated with 10 mg rifampin/kg of body weight daily (6), much below the reference concentration of 8 mg/ liter (5). In addition, both murine models (1) and studies with TB patients (3) suggest that the typical 10-mg/kg dose of ri-fampin may be too low and that a higher dose may reduce treatment duration (4). Indeed, a regimen incorporating a higher dose of 1,200 mg rifampin daily yielded much faster conversion of sputum culture (2). Based on these findings, we decided to investigate the effect of increasing the dose of ri-fampin in terms of pharmacokinetics and tolerability. In an open-label phase II randomized clinical trial in an urban clinic in Indonesia, consecutive patients with microbio-logically proven pulmonary TB were randomized to a standar