Chemotherapy Of Mycobacterium Avium Complex

Clarithromycin and azithromycin both have excellent activity against many strains of MAC, with clinical responses (decrease or elimination of bacteremia, resolution of fever and night sweats) demonstrated even with single-drug therapy. To avoid resistance, most clinicians treat disseminated MAC infections with clarithromycin or azithromycin plus ethambutol. In some situations, rifabutin, clofazimine, and/or a quinolone are added. Drug interactions and adverse drug reactions are common with multiple-drug regimens, necessitating drug discontinuation in ~50% of patients. Clinical improvement is expected in the first 1-2 months of treatment, with sterilization of blood cultures within 3 months of starting therapy. Treatment of MAC infection in HIV-infected individuals typically is lifelong. Isoniazid and pyrazinamide have no role in the treatment of MAC infection.

Prophylaxis of MAC infection with clarithromycin or azithromycin should be strongly considered for HIV-infected persons whose CD4 count is <50/mm3.

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