Steady-state serum pharmacokinetics of novobiocin and rifampin alone and in combination.

Because of the potential of novobiocin-rifampin for oral therapy of methicillin-resistant Staphylococcus aureus infection, we evaluated the pharmacokinetics of novobiocin and rifampin, alone and in combination, in a randomized, crossover, multiple-dose evaluation (500 mg of novobiocin and 300 mg of rifampin administered orally, twice a day, for 27 doses) in 10 volunteers. The half-lives of novobiocin and rifampin when administered alone were 5.85 +/- 1.20 and 1.46 +/- 0.30 h, respectively; when administered in combination, the half-lives were 2.66 +/- 0.65 and 1.43 +/- 0.29 h, respectively. This difference was significant for novobiocin. The area under the curve also differed significantly for novobiocin when administered in combination. No significant differences were seen in the maximum concentration of drug in serum, the time to maximum concentration of drug in serum, or both for either drug when single and combination therapy groups were compared. A change in clearance of novobiocin rather than a change in absorption is the more likely explanation for these findings. The mechanism remains to be elucidated. Nevertheless, the trough serum concentrations of both novobiocin and rifampin were in excess of the MIC for 90% of strains tested of methicillin-resistant S. aureus, even when coadministered.