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The combination of rifampin and pyrazinamide for 2 to 3 months is considered a less preferable alternative. Trials of this regimen have inched only HIV-positive patients, and the efficacy of this regimen in HIV-negative patients has not been confirmed. There are recent case reports of severe and fatal hepatitis in patients on rifampin and pyrazinamide, and, therefore, this regimen should be particularly avoided in those with underlying liver disease or alcohol abuse. If these agents are used, liver enzymes should be measured at baseline and then monitored closely every 2 weeks. For patients with HIV, the use of rifampin may be contraindicated with certain protease inhibitors and non-nucleoside reverse transcriptase inhibitors used in antiretroviral therapy. A substitution of rifabutin for rifampin is recommended in these instances. Rifabutin should not be used with the protease inhibitor ritonavir, the non-nucleoside reverse transcriptase inhibitor delavirdine, or the hard gel of saquinavir, and cautions should be used with patients taking the soft gel form of saquinavir.*57/348/5*

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