Limited Use Note(s) |
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RIFABUTIN150mg Cap
Reason For Use Code | Clinical Criteria |
---|---|
For the prevention of Mycobacterium Avium Intracellular (MAI) in: | |
103 | Patients with a CD4+ cell count less than 200/mm3 with an AIDS-defining diagnosis; |
LU Authorization Period: 1 year | |
104 | Patients with a CD4+ cell count less than 100/mm3 without an AIDS-defining diagnosis. |
LU Authorization Period: 1 year |