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Clarithromycin and Other Antimicrobial Agents in the Treatment of Disseminated Mycobacterium avium Infections in Patients With Acquired Immunodeficiency Syndrome
Bertrand Dautzenberg, MD;
T. Saint Marc, MD;
M. C. Meyohas, MD;
M. Eliaszewitch, MD;
F. Haniez, MD;
A. M. Rogues, MD;
S. De Wit, MD;
L. Cotte, MD;
J. P. Chauvin, MD;
J. Grosset, MD
Arch Intern Med. 1993;153(3):368-372.
Abstract
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Background
Disseminated infection with Mycobacterium avium is common with late-stage acquired immunodeficiency syndrome (AIDS), and no antimicrobial agent has been found to be clearly effective.
Methods
A multicenter open trial was conducted to assess the antimicrobial activity and clinical efficacy of clarithromycin—a new macrolide antibiotic—against disseminated M avium in 77 patients with late-stage AIDS. Blood cultures were taken at baseline and during treatment; side effects were also evaluated.
Results
Mycobacterium avium was eradicated from blood cultures in 11 (63%) of 16 evaluable patients receiving daily doses or 500 or 1000 mg, (n=21) and in 45 of 46 (98%) of those receiving 1500 or 2000 mg (n=56). Eradication after 2 months was influenced by continuity of drug treatment; 36 of 42 patients with no relapse had received continuous treatment vs six of 14 patients whose drug treatment had been stopped for 7 days or longer. After 2 to 7 months of treatment, acquired resistance associated with relapse was observed. Drug side effects were elevated liver enzyme levels (26%) and impaired hearing (4%). Concomitant AIDS drugs had no favorable effect on outcome and may have worsened liver toxicity.
Conclusions
Clarithromycin has bacteriologic efficacy against M avium infection in late-stage AIDS, although drug resistance eventually develops. Further studies are needed to investigate safe, effective concomitant drugs.
(Arch Intern Med. 1993;153:368-372)
Author Affiliations
From the Pulmonary Department (Dr Dautzenberg) and Bacteriology-Virology Laboratories (Dr Grosset), Groupe Hospitalier Pitié-Salpêtrière, Paris, France; Department of Clinical Immunology and Transplantation, Hôpital E. Herriot, Lyon, France (Dr Saint Marc); Department of Infectious Disease, Hôpital Saint Antoine, Paris (Dr Meyohas); Department of Infectious Disease, Hôpital Pasteur, Paris (Dr Eliaszewitch); Department of Infectious Disease, C. M. C. de Bligny, Briis/Forges, France (Dr Haniez); Department of Infectious Disease, Hôpital Pellegrin, Bordeaux, France (Dr Rogues); Department of Infectious Disease, Hôpital Saint Pierre, Brussels, Belgium (Dr De Wit); Hepatitis and AIDS Unit, Hôpital Hôtel Dieu, Lyon (Dr Cotte); and Abbott France, Rungis (Dr Chauvin).
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