Mycobacterium avium complex clarithromycin effect

The incidence of disseminated Mycobacterium avium complex (MAC) infection has increased dramatically with the AIDS epidemic. Treatment regimens for patients with a positive culture for MAC from a sterile site should include two or more drugs, including clarithromycin. Prophylaxis against disseminated MAC should be considered for patients with a CD4 cell count of less than 50 X 10 /1 (5). In a randomized, open trial in 37 patients with HIV-associated disseminated MAC infection, treatment with clarithromycin -I- ethambutol produced more rapid resolution of bacteremia, and was more effective at sterilization of blood cultures after 16 weeks than azithromycin -I- ethambutol (6). 

CLARITHROMYCIN NNRTIs 1. i efficacy of clarithromycin but t efficacy and adverse effects of the active metabolite 2. A rash occurs in 46% of patients when efavirenz is given with clarithromycin 1. Uncertain possibly due to altered CYP3A4-mediated metabolism 2. Uncertain 1. Clinical significance unknown no dose adjustment is recommended when clarithromycin is co-adminis-tered with nevirapine, but monitor LFTs and activity against Mycobacterium avium intracellulare complex closely 2. Consider alternatives to clarithromycin for patients on efavirenz... 

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