Mycobacterium avium-intracellular

Sisson, P. R. Freeman, R. Magee, J. G Lightfoot, N. F. Rapid differentiation of Mycobacterium xenopi from mycobacteria of the Mycobacterium avium-intracellulare complex by pyrolysis mass spectrometry. J. Clin. Path. 1992, 45, 355-357. 

Toxoplasma gondii, Lelshmania donovani. Listeria monocytogenes, and Mycobacterium avium intracellulare. Interferon gamma-lb was found to enhance osteoclast function in vitro. 

Increasingly the existence of multiresistant strains is reported, especially in the United States but also elsewhere. Also the occurrence of infections with difficult to treat, so called atypical mycobacteria like Mycobacterium avium intracellulare and Mycobacterium kansasii is on the rise. These infections are especially seen in patients with a compromised immune system. In vitro these atypical mycobacteria often show resistance against first-choice drugs. However this in vitro lack of sensitivity does not always correspond with in vivo responses. 

Rifabutin, a semi-synthetic derivative of rifamy-cin S, is a bactericidal antibiotic primarily used in the treatment of tuberculosis. Its effect is based on blocking the DNA-dependend RNA-polymerase of the bacteria. Rifabutin is used in the treatment of infections with Mycobacterium avium intracellulare. Rifabutin is well tolerated in patients with HIV-related tuberculosis, but patients with low CD4 cell counts have a high risk of treatment failure or relapse due to acquired rifamycin resistance. 

Ethambutol is a water-soluble, heat-stable compound that acts by inhibition of arabinosyl transferase enzymes that are involved in cell wall biosynthesis. Nearly all strains of M tuberculosis and M. kansasii and most strains of Mycobacterium avium-intracellulare are sensitive to ethambutol. Drug resistance relates to point mutations in the gene (EmbB) that encodes the arabinosyl transferases that are involved in mycobacterial cell wall synthesis. 

B. V. Wichert, R. J. Gonalez-Rothi, L. E. Straub, B. M. Wichert, and H. Schreier, Amikacin liposomes preparation, characterization, and in vitro activity against Mycobacterium avium-intracellulare infection in alveolar macrophages, Int. J. Pharm. 78 221 (1992). 

Azithromycin, though less active against streptococci and staphylococci than erythromycin, is far more active against respiratory infections due to Haemophilus influenzae and Moraxella catarrhalis. Except for its cost, it is now the preferred therapy for urethritis caused by Chlamydia trachomatis. Its activity against Mycobacterium avium intracellulare complex has not proven to be clinically important, except in AIDS patients with disseminated infections. 

Fourteen different reference strains of mycobacteria from Central JALMA Institute of Leprosy, Agra, India, isolated from clinical specimens, have been screened for the in vitro studies. Among these were several members of slow-growing atypical mycobacteria, e.g., Mycobacterium marinum 50, Mycobacterium scrofulaceum 1323, Mycobacterium gordonae 1324, Mycobacterium ter-rae 1450, Mycobacterium tuberculosis H37RV 16, and H37Rv (102, Kl, K2). Two other strains, known as the ICRC [41] and Skinsnes bacillus [31], which had been isolated from human leproma and found to be the members of the Mycobacterium avium-intracellulare-scrofulaceum, were also included in this study. 

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... 

CLARITHROMYCIN, ERYTHROMYCIN PROTEASE INHIBITORS Possibly t adverse effects of macrolide with atazanavir, ritonavir (with or without lopinavir) and saquinavir Inhibition of CYP3A4- and possibly CYP1 A2-mediated metabolism. Altered transport via P-gp may be involved. Amprenavir and indinavir are also possibly t by erythromycin Consider alternatives unless there is Mycobacterium avium intracellulare infection if combined, 1 dose by 50% (75% in the presence of renal failure with a creatinine clearance of <30mL/min)... 

Roussel G, Igual J. Clarithromycm with minocychne and clofazimine for Mycobacterium avium intracellulare complex lung disease m patients without the acquired immune deficiency syndrome. GETIM. Groupe d Etude et de Traitement des Infections a Mycobacteries. Int J Tuberc Lung Dis 1998 2(6) 462-70. 

Tyagi AK, Kayarkar W, McDonneh PJ. An imreported side effect of topical clarithromycm when used successfuhy to treat Mycobacterium avium-intracellulare keratitis. Cornea 1999 18(5) 606-7. 

Barradell LB, Plosker GL, McTavish D. Clarithromycin. A review of its pharmacological properties and therapeutic use in Mycobacterium avium-intracellulare complex infection in patients with acquired immune deficiency syndrome. Drugs 1993 46(2) 289-312. 

Azithromycin has a similar spectrum but is more active, especially versus organisms associated with sinusitis or otitis media (H. influenzae, M. catarrhalis), Chlamydia (co-DOC, including co-infections with gonorrhea), and Mycobacterium avium-intracellulare. 

Infection caused by P. carinii, Toxoplasma gondii, and Mycobacterium avium-intracellulare Sickle-cell crisis Toxoplasmosis... 

Precursor-directed biosynthesis has produced novel analogues of the massetolides (2-9), cyclic depsipeptides [9]. This is a promising family of natural products as massetolide A (2) exhibits potent, selective activity against Mycobacterium tuberculosis, the causative agent for tuberculosis, and Mycobacterium avium-intracellulare, a bacterium which causes... 

SimOar spectrum, but is more active in respiratory infections, including Mycobacterium avium-intracellulare... 

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