Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Long-term outcomes of treatment of Mycobacterium avium complex bacteremia using a clarithromycin-containing regimen.
AIDS. 1998 Jul 30;12(11):1309-15. Unique Identifier : AIDSLINE MED/98372115 Burman WJ; Stone BL; Rietmeijer CA; Maslow J; Cohn DL; Reves RR; Disease Control Service and the Mycobacteriology Laboratory,; Denver Public Health, Colorado 80204, USA.
Abstract:
OBJECTIVES: To describe the long-term outcomes of treatment of AIDS-related Mycobacterium avium complex (MAC) bacteremia using a standard clarithromycin-based regimen. DESIGN: Retrospective study of patients with MAC bacteremia diagnosed between April 1992 and April 1995. SETTING: An urban AIDS clinic SUBJECTS: One hundred seventy-six consecutive patients with MAC bacteremia. INTERVENTIONS: Clarithromycin 500 mg twice daily, ethambutol 800 or 1200 mg daily, and clofazimine 100 mg daily. MAIN OUTCOME MEASURES: Late treatment failure (defined as a positive blood culture more than 90 days after starting treatment), clarithromycin susceptibility of initial and treatment-failure isolates, DNA fingerprinting of isolates from treatment failures. RESULTS: Two out of 176 (1.1%) baseline isolates were resistant to clarithromycin. One hundred and fifty-one patients were treated for MAC bacteremia, 144 (95%) with the standard regimen. Of the 117 patients who survived > 90 days after starting therapy, 25 (21%) met the criteria for late treatment failure. Of the 22 treatment-failure isolates available for susceptibility testing, 19 (86%) were resistant to clarithromycin. Therefore, 13% of patients treated using the standard regimen (19 out of 144) had treatment failure associated with the emergence of clarithromycin resistance. Using logistic regression, non-compliance was associated with treatment failure (P = 0.02). Fourteen out of the 17 (82%) evaluable paired isolates had identical DNA fingerprint patterns, whereas three pairs showed that a different strain of MAC was present at the time of treatment failure. CONCLUSIONS: Initial resistance to clarithromycin was rare during this period. However, late treatment failure associated with the emergence of clarithromycin resistance was relatively common during long-term follow-up. Most late treatment failures represented emergence of clarithromycin resistance in the initial strain.
Keywords: JOURNAL ARTICLE Adult Antibiotics, Macrolide/*THERAPEUTIC USE Antitubercular Agents/*THERAPEUTIC USE AIDS-Related Opportunistic Infections/*DRUG THERAPY/MICROBIOLOGY Bacteremia/COMPLICATIONS/*DRUG THERAPY/MICROBIOLOGY Clarithromycin/*THERAPEUTIC USE Drug Resistance, Microbial Drug Therapy, Combination Female Follow-Up Studies Human Male *Mycobacterium avium Complex Mycobacterium avium-intracellulare Infection/COMPLICATIONS/*DRUG THERAPY/MICROBIOLOGY Retrospective Studies Support, U.S. Gov't, P.H.S. Time Factors Treatment Outcome 990130
A9911063
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Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
