Rifampicin
| Evidence Level: L3 | Predicted Indications: 10 |
Table of Contents
Rifampicin: From Tuberculosis to Conjunctivitis
One-Sentence Summary
Rifampicin is a rifamycin-class antibiotic originally developed as a first-line treatment for tuberculosis and other mycobacterial infections. The TxGNN model predicts it may also be effective for Conjunctivitis, but this is currently supported only by 20 publications — largely historical case reports, susceptibility studies and one 1970s controlled trial — with no registered clinical trials.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Tuberculosis (rifampicin is a first-line anti-tubercular antibiotic; no indication text was provided in this evidence pack, so this reflects established pharmacological knowledge rather than a sourced record) |
| Predicted New Indication | Conjunctivitis |
| TxGNN Prediction Score | 99.95% |
| Evidence Level | L3 |
| UK Market Status | Not marketed (per evidence pack; 0 licences on record) |
| Number of Marketing Authorisations | 0 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available in this evidence pack (flagged as a High-severity data gap). Based on established pharmacology, rifampicin is a rifamycin that inhibits bacterial DNA-dependent RNA polymerase, giving it a broad antibacterial spectrum extending beyond Mycobacterium species to include organisms such as Chlamydia trachomatis and Neisseria meningitidis.
Tuberculosis and conjunctivitis are not anatomically related, but the TxGNN link appears to be pathogen-driven rather than organ-driven: several of the organisms rifampicin acts against — notably C. trachomatis (the cause of trachoma, a severe conjunctival infection) and N. meningitidis — are also recognised causes of conjunctivitis.
This mechanistic plausibility is reinforced by historical clinical use: topical rifampicin was trialled for endemic trachoma in the 1970s with results comparable to tetracycline, and systemic rifampicin has been used as adjunctive/prophylactic therapy in cases of primary meningococcal conjunctivitis. However, this body of evidence predates modern trial registries and has not been revisited with contemporary clinical trial methodology.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 1096630 | 1975 | Controlled trial | American Journal of Ophthalmology | Topical 1% rifampicin ointment compared with tetracycline and boric acid ointment in Tunisian schoolchildren with trachoma; rifampicin performed comparably to tetracycline over 39 weeks’ follow-up |
| 6635446 | 1983 | Review | Reviews of Infectious Diseases | Identifies rifampin as the most active antimicrobial by weight against Chlamydia trachomatis; as effective as tetracyclines for topical trachoma treatment, though rapid emergence of resistance limits clinical trial use |
| 5411121 | 1970 | Preclinical study | Nature | Laboratory evaluation of anti-trachoma activity of rifampicin and rifamycin SV derivatives |
| 19941479 | 2010 | Review | Current Medicinal Chemistry | Review of neglected bacterial diseases including trachoma; notes historical use of rifampin/streptomycin combinations |
| 15228931 | 2004 | Review | Anales de Pediatría (Barcelona) | Review of the most prevalent pathogens and antibiotic sensitivity patterns in bacterial conjunctivitis |
| 10537781 | 1999 | Review | Current Opinion in Ophthalmology | Reviews ocular manifestations of cat-scratch disease (Bartonella henselae), including Parinaud’s oculoglandular syndrome presenting as conjunctivitis |
| 14686993 | 2003 | Case report | Clinical Microbiology and Infection | Case of primary meningococcal conjunctivitis in a child, treated with topical polymyxin/neomycin/gramicidin followed by systemic rifampin, with no complications |
| 7806886 | 1994 | Case series | The Journal of Infection | Three cases of primary meningococcal conjunctivitis with systemic sepsis; recommends combined topical/parenteral therapy plus rifampicin chemoprophylaxis for close contacts |
| 33457332 | 2020 | Observational study | Advanced Biomedical Research | Bacterial aetiology and antibiotic susceptibility of conjunctivitis isolates in Kashan, Iran |
| 5005929 | 1971 | Historical report | Annals of Ophthalmology | Early ophthalmology report on rifampicin (abstract not available) |
Safety Considerations
Please refer to the SmPC and BNF for safety information. Report suspected adverse reactions via the Yellow Card Scheme.
Note: This evidence pack flags a Blocking data gap (TFDA/MHRA warnings and contraindications not yet retrieved), meaning a full safety pre-assessment (S1) cannot currently be completed for this candidate.
Conclusion and Next Steps
Decision: Hold
Rationale: The predicted indication is supported only by historical, low-quality evidence (one 1970s controlled trial, case reports and susceptibility studies) with no modern registered clinical trials, no confirmed UK marketing authorisation, and a Blocking gap in safety labelling data that prevents a proper safety pre-assessment.
To proceed, the following is needed:
- MHRA/BNF SmPC data on warnings and contraindications (resolves the Blocking data gap)
- Confirmed original mechanism of action documentation
- Verification of current UK marketing/licensing status for rifampicin-containing products
- A contemporary clinical evaluation (the only comparative trial data for conjunctivitis/trachoma is >45 years old)
Note on Other Predicted Indications in This Multi-Candidate Pack
This evidence pack (TW-DB01045-multi) scored ten predicted indications for rifampicin. For context, alongside conjunctivitis (rank 1, above):
| Rank | Disease | Evidence Level | Recommendation | Key Issue |
|---|---|---|---|---|
| 2 | Multiple endocrine neoplasia | L5 | Hold | No mechanistic link; high-score/no-evidence prediction |
| 3 | Acne (disease) | pending | — | Literature relates to clindamycin+rifampicin combination for hidradenitis suppurativa, not rifampicin monotherapy |
| 4 | Conjunctivitis (disease) | pending | — | Duplicate/overlapping KG node with rank 1 |
| 5 | HIV infectious disease | L4 | Hold | Mechanism confusion — trials are TB treatment/PK studies in HIV-TB co-infected patients, not anti-HIV activity; rifampicin is a strong CYP3A4 inducer with major ARV interaction risk |
| 6 | Rare neurodevelopmental disorder | L5 | Hold | No mechanistic or evidentiary link |
| 7 | Rheumatoid arthritis | L3 | Research Question | Antibiotic-for-RA hypothesis; trial composition needs verification to confirm rifampicin was an active component |
| 8 | Acute contagious conjunctivitis | pending | — | Duplicate/overlapping KG node with rank 1 |
| 9 | Feline immunodeficiency-related disease | L5 | Hold | Veterinary disease label; likely KG node mismatch |
| 10 | Simian immunodeficiency virus infection | L4 | Hold | Same mechanism confusion as HIV entry; macaque TB/SIV co-infection models, not antiviral evidence |
The conjunctivitis prediction (rank 1) is the only one in this pack with a biologically coherent mechanism and any historical clinical precedent, which is why it was selected as the lead candidate for this report.
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.