Adverse events associated with high-dose rifabutin in macrolide-containing regimens for the treatment of Mycobacterium avium complex lung disease.

Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Adverse events associated with high-dose rifabutin in macrolide-containing regimens for the treatment of Mycobacterium avium complex lung disease.

Clin Infect Dis. 1995 Sep;21(3):594-8. Unique Identifier : AIDSLINE MED/96077379
Griffith DE; Brown BA; Girard WM; Wallace RJ Jr; Department of Medicine, University of Texas Health Center, Tyler; 75710, USA.

Abstract: We initiated a multidrug trial that included high-dose rifabutin for the treatment of pulmonary Mycobacterium avium complex (MAC) disease. Twenty-six patients received rifabutin (600 mg/d) in combination with ethambutol, streptomycin, and either clarithromycin (500 mg b.i.d.; 15 patients) or azithromycin (600 mg/d; 11 patients). Rifabutin-related adverse events occurred in 77% of patients. Fifty-eight percent of patients required a dosage adjustment or discontinuance of rifabutin therapy. The most common adverse event was a reduction in the mean total white blood cell (WBC) count, which decreased from 8,600 +/- 2,800/mm3 before treatment to 4,500 +/- 2,100/mm3 during treatment (P = .0001). Although all patients had some decrease in WBC count, only three patients (12%) required a dosage adjustment for this reason. Other common adverse events included gastrointestinal symptoms (nausea, vomiting, or diarrhea; 42%) and abnormal liver enzyme levels (12%). Eight of 11 patients (73%) with gastrointestinal symptoms, including one patient with abnormal liver enzyme levels, required a rifabutin-dosage adjustment. The most severe adverse events, always requiring an adjustment of therapy, were a diffuse polyarthralgia syndrome (19%) and anterior uveitis (8%). The latter toxicity has previously been reported to occur only in patients with AIDS and was seen only in patients who also were receiving clarithromycin. On the basis of the current findings, we recommend that rifabutin be used at a dose of 300 mg/d in multidrug regimens that include a macrolide for treatment of MAC lung disease.

Keywords: Adult Aged Antibiotics, Combined/*ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Antibiotics, Macrolide/*ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Arthralgia/CHEMICALLY INDUCED Drug Interactions Drug Tolerance Female Gastrointestinal System/DRUG EFFECTS Human Leukopenia/CHEMICALLY INDUCED Liver/DRUG EFFECTS/ENZYMOLOGY Lung Diseases/*DRUG THERAPY Male Middle Age Mycobacterium avium-intracellulare Infection/*DRUG THERAPY Rifabutin/*ADMINISTRATION & DOSAGE/*ADVERSE EFFECTS Support, Non-U.S. Gov't CLINICAL TRIAL JOURNAL ARTICLE
960430
M9640833

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted funding from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, Gill Foundation, the National Library of Medicine, Quest Diagnostics, Roche and Trimeris, and donations from users like you. Always watch for outdated information. This article first appeared in 1996. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1996. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .