Rifampicin for COVID-19

Abstract

Vaccinations for coronavirus disease-2019 (COVID-19) have begun more than a year before, yet without specific treatments available. Rifampicin, critically important for human medicine (World Health Organization’s list of essential medicines), may prove pharmacologically effective for treatment and chemoprophylaxis of healthcare personnel and those at higher risk. It has been known since 1969 that rifampicin has a direct selective antiviral effect on viruses which have their own RNA polymerase (severe acute respiratory syndrome coronavirus 2), like the main mechanism of action of remdesivir. This involves inhibition of late viral protein synthesis, the virion assembly, and the viral polymerase itself. This antiviral effect is dependent on the administration route, with local application resulting in higher drug concentrations at the site of viral replication. This would suggest also trying lung administration of rifampicin by nebulization to increase the drug’s concentration at infection sites while minimizing systemic side effects. Recent in silico studies with a computer-aided approach, found rifampicin among the most promising existing drugs that could be repurposed for the treatment of COVID-19.

Keywords: COVID-19; SARS-CoV-2; Rifampicin; Antiviral activity; RNA polymerase

Core Tip: Rifampicin may prove pharmacologically effective, supplying a possible and cost-effective solution to the global battle against severe acute respiratory syndrome coronavirus 2, not only for treatment but also for chemoprophylaxis of those at higher risk. It is also possible to administer rifampicin by nebulization. The publications describing the in vitro mechanisms and providing proof of clinical efficacy of rifampicin against RNA viruses with their own RNA polymerase have emerged since 1969-1971. Recent in silico studies using a computer-aided approach, found rifampicin among the most promising existing drugs that can be repurposed for the treatment of coronavirus disease-2019.