Mycobacterium avium complex infections treatment

Mycobacterium avium-Complex Infection Progress in Research and Treatment, edited by J. A. Korvick and C. A. Benson... 

Treatment regimens for Mycobacterium avium complex infection should contain at least two antimycobacterial agents. Every regimen should contain either clarithromycin or azithromycin plus a second agent such as ethambutol. 

The aminoglycoside (see Section II.c) streptomycin was the first antimycobacterial antibiotic. It has activity against extracellular mycobacteria with a high growth rate. The macrolide antibiotics azithromycin and clarithromycin (see Section Il.d.l) were approved for the treatment of disseminated mycobacterial infections due to Mycobacterium avium complex. 

Unlabeled Uses Treatment of atypical mycobacterial infections such as Mycobacterium avium complex (MAC)... 

Faris MA, Raasch RH, Hopfer RL, Butts JD. Treatment and prophylaxis of disseminated Mycobacterium avium complex in HIV-infected individuals. Ann Pharmacother... 

Griffith DE, Brown BA, Girard WM, Wallace RJ Jr. Adverse events associated with high-dose rifabutin in macrolide-con-taining regimens for the treatment of Mycobacterium avium complex lung disease. Clin Infect Dis 1995 21(3) 594-8. 

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). 

Benson CA, Williams PL, Currier IS, et al. A prospective, randomized trial examining the efficacy and safety of clarithromycin in combination with ethambutol, rifabutin, or both for the treatment of disseminated Mycobacterium avium complex disease in persons with acquired immunodeficiency syndrome. CUn Infect Dis 2003 37 1234-1243. 

Azithromycin is a macrolide (erythromycin, clarithromycin, and azithromycin) that interferes with microbial protein synthesis. It is indicated in the following conditions. Adults treatment of infections of the respiratory tract, acute bacterial sinusitis, acute bacterial exacerbations of COPD, community-acquired pneumonia, Mycobacterium avium complex, pelvic inflammatory disease, pharyngitis/tonsilli-tis, skin and skin structure infections, and sexually transmitted diseases caused by susceptible organisms. Children treatment of acute bacterial sinusitis, acute otitis media caused by susceptible organisms, community-acquired pneumonia, pharyngitis/tonsillitis caused by S. pyogenes in patients who cannot use first-line therapy. 

Clarithromycin is an H. pylori agent/macrolide, which inhibits microbial protein synthesis. Clarithromycin is indicated in the treatment of infections of the respiratory tract, skin and skin structure treatment of disseminated atypical mycobacterial infections caused by susceptible strains of specific microorganisms and prevention of disseminated Mycobacterium avium complex disease in patients with advanced HIV infection. Clarithromycin in combination with omeprazole is indicated in the treatment of patients with an active duodenal ulcer associated with H. pylori infection. In children it is used in acute otitis media. Macrolides are erythromycin, clarithromycin, and azithromycin. 

Chaisson, R. E., Keiser, P., Pierce, M., Fessel, W. J., Ruskin, J., Lahart, C., Benson, C. A., Meek, K., Siepman, N., and Craft, J. C. (1997). Clarithromycin and ethambutol with or without clofazimine for the treatment of bacteremic Mycobacterium avium complex disease in patients with HIV infection. AIDS 11, 311-317. 

Anterior Segment Glucocorticoids also have been implicated in cataract formation. If vision is reduced, cataract surgery may be necessary. Rifabutin, if used in conjunction with clarithromycin or fluconazole for treatment of Mycobacterium avium complex (MAC) opportunistic infections in AIDS, is associated with an iridocyclitis and even hypopyon. This will resolve with glucocorticoids or by stopping the medication. 

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