MAI

MAI

AIDS Treatment Update, No. 44, August 1996
Edward King

Clarithromycin is more effective than rifabutin at preventing symptomatic MAI among people with CD4 counts below 100, according to American research. The combination of both drugs was also better than rifabutin alone, but not significantly better than clarithromycin alone. However, nearly a third of people given clarithromycin developed clarithromycin-resistant MAI strains that can be harder to treat. Rifabutin was not associated with the development of resistance (We.B.421). Dr Brian Gazzard commented that the high incidence of resistance to clarithromycin makes it an "unacceptable" option for prophylaxis.

Another study compared two different doses of clarithromycin when used as part of three-drug combinations to treat active MAI. It found that people receiving the higher dose of clarithromycin (1000 mg twice daily) had a significantly higher death rate than people taking the lower dose (500 mg twice daily). No explanation other than the effect of the drug could be found (LB.B.6025). On July 23rd the US National Institutes of Health issued a letter to doctors warning them against using doses of clarithromycin higher than 500 mg twice daily.

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