Rifabutin (Rfb) is an antibiotic used to treat tuberculosis and prevent and treat Mycobacterium avium complex. It is typically only used in those who cannot tolerate rifampin such as people with HIV/AIDS on antiretrovirals. For active tuberculosis it is used with other antimycobacterial medications. For latent tuberculosis it may be used by itself when the exposure was with drug-resistant TB.Common side effects include abdominal pain, nausea, rash, headache, and low blood neutrophil levels. Other side effects include muscles pains and uveitis. , especially when hitting Bartonella and Babesia colonies in the capillaries of the ciliary body in the eye anterior chamber. While no harms have been found during pregnancy it has not been well studied in this population. Rifabutin is in the rifamycin family of medications. It works by blocking RNA production in bacteria.Rifabutin was approved for medical use in the United States in 1992. It is on the World Health Organizations List of Essential Medicines. Medical uses
Rifabutin is now recommended as first-line treatment for tuberculosis (TB), but rifampicin was used more widely because of its cheaper cost. However, due to the expiration of patents, prices are now similar. Rifabutin is also used in the treatment of Mycobacterium avium complex disease, a bacterial infection most commonly encountered in people with late-stage AIDS. Its has fewer drug interactions than rifampicin, therefore people with HIV/AIDS on HAART are typically prescribed rifabutin instead of rifampicin for the treatment of TB.
Diagnosis
Criteria
According to the American Diabetes Association, diagnostic features include:
Plasma glucose level >30 mmol/L (>600 mg/dL)
Serum osmolality >320 mOsm/kg
Profound dehydration, up to an average of 9L (and therefore substantial thirst (polydipsia))
Serum pH >7.30
Bicarbonate >15 mEq/L
Small ketonuria (~+ on dipstick) and absent-to-low ketonemia (<3 mmol/L)
Some alteration in consciousness
BUN > 30 mg/dL (increased)
Creatinine > 1.5 mg/dL (increased)

Imaging
Cranial imaging is not used for diagnosis of this condition. However, if MRI is performed, it may show cortical restricted diffusion with unusual characteristics of reversible T2 hypointensity in the subcortical white matter. Differential diagnosis
The major differential diagnosis is diabetic ketoacidosis (DKA). In contrast to DKA, serum glucose levels in HHS are extremely high, usually greater than 40-50 mmol/L (600 mg/dL). Metabolic acidosis is absent or mild. A temporary state of confusion (delirium) is also more common in HHS than DKA. HHS also tends to affect older people more. DKA may have fruity breath, and rapid and deep breathing.DKA often has serum glucose level greater than 300 mg/dL (HHS is >600 mg/dL). DKA usually occurs in type 1 diabetics whereas HHS is more common in type 2 diabetics. DKA is characterized by a rapid onset, and HHS occurs gradually over a few days. DKA also is characterized by ketosis due to the breakdown of fat for energy.Both DKA and HHS may show symptoms of dehydration, increased thirst, increased urination, increased hunger, weight loss, nausea, vomiting, abdominal pain, blurred vision, headaches, weakness, and low blood pressure with standing. Management
Intravenous fluids
Treatment of HHS begins with reestablishing tissue perfusion using intravenous fluids.