Successful short-term suppression of clarithromycin-resistant Mycobacterium avium complex bacteremia in AIDS. California Collaborative Treatment Group.

Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Successful short-term suppression of clarithromycin-resistant Mycobacterium avium complex bacteremia in AIDS. California Collaborative Treatment Group.

Clin Infect Dis. 1999 Jan;28(1):136-8. Unique Identifier : AIDSLINE MED/99152410
Dube MP; Torriani FJ; See D; Havlir DV; Kemper CA; Leedom JM; Tilles JG; McCutchan JA; Sattler FR; University of Southern California School of Medicine, Los; Angeles. mdube@hsc.usc.edu

Abstract: During a randomized study of clarithromycin plus clofazimine with or without ethambutol in patients with AIDS and Mycobacterium avium complex (MAC) bacteremia, eight participants received additional antimycobacterial drugs following the detection of a clarithromycin-resistant isolate (MIC, > 8 micrograms/mL). A macrolide (seven received clarithromycin, one azithromycin) and clofazimine were continued; additional treatment included various combinations of ethambutol, ciprofloxacin, amikacin, and rifabutin. After the detection of a resistant isolate and before receipt of additional antimycobacterials, the median peak MAC colony count in blood was 105 cfu/mL (range, 8-81,500 cfu/mL). After additional antimycobacterials, the median nadir MAC colony count was 5 cfu/mL (range, 0-110 cfu/mL). Five (63%) of eight patients had a > or = 1 log10 decrease, including two who achieved negative blood cultures; all of these responses occurred in patients originally assigned to clarithromycin plus clofazimine. Treatment of clarithromycin-resistant MAC bacteremia that emerges during clarithromycin-based treatment can decrease levels of bacteremia and transiently sterilize blood cultures.

Keywords: CLINICAL TRIAL JOURNAL ARTICLE RANDOMIZED CONTROLLED TRIAL Antibiotics, Combined/*THERAPEUTIC USE AIDS-Related Opportunistic Infections/*DRUG THERAPY/MICROBIOLOGY Bacteremia/*DRUG THERAPY/MICROBIOLOGY Ciprofloxacin/THERAPEUTIC USE Clarithromycin/PHARMACOLOGY Clofazimine/THERAPEUTIC USE Drug Resistance, Microbial Drug Therapy, Combination Ethambutol/THERAPEUTIC USE Human Mycobacterium avium Complex/*DRUG EFFECTS/ISOLATION & PURIF Mycobacterium avium-intracellulare Infection/*DRUG THERAPY/ MICROBIOLOGY Rifabutin/THERAPEUTIC USE Support, Non-U.S. Gov't
990930
A9991303

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