Azithromycin for treatment of Mycobacterium avium-intracellulare complex infection in patients with AIDS

• Published in: The Lancet (British edition) Vol. 338; no. 8775; pp. 1107 - 1109
• Main Authors: Young, L.S., Wu, M., Kolonoski, P., Bolan, R., Inderlied, C.B., Wiviott, L.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 02.11.1991; Elsevier Limited
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - complications; Administration, Oral; Adult; AIDS; AIDS/HIV; Anaphylaxis; Antibiotics; Azithromycin; Bacteremia; Bacteremia - complications; Bacteremia - drug therapy; Bacteria; Bacterial infections; Diarrhea; Drug Administration Schedule; Drug dosages; Drug Evaluation; Erythromycin - administration & dosage; Erythromycin - analogs & derivatives; Erythromycin - therapeutic use; Fever; Follow-Up Studies; Food allergies; Homosexuality; Humans; Infections; Liver; Male; Medical research; Mycobacterium avium; Mycobacterium avium-intracellulare Infection - complications; Mycobacterium avium-intracellulare Infection - drug therapy; Opportunistic Infections - complications; Opportunistic Infections - drug therapy; Patients
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/0140-6736(91)91965-W

Mycobacterium avium complex infection is common in patients with AIDS. Experimentally infected mice have been treated successfully with azithromycin, a macrolide antibiotic. We report an uncontrolled phase I study in which male homosexuals with AIDS and M avium complex disease were given 500 mg azithromycin per day orally for 10, 20, or 30 days. Quantitative blood cultures showed a mean reduction in mycobacteraemia from 118 colony forming units (cfu)/ml to 43 cfu/ml in 3 patients treated for 10 days, and from 2028 cfu/ml to 136 cfu/ml in 21 patients treated for 20 or 30 days. Of the patients treated for 20 or 30 days, 15 of 21 with fever pretreatment and 12 of 18 with night sweats pretreatment reported resolution of these symptoms. The principal side-effects were loose stools or diarrhoea, but these did not result in cessation of therapy. Azithromycin, as a single oral agent, safely reduced M avium complex bacteraemia and associated symptoms in almost 75% of patients treated for at least 20 days. Further studies are needed to assess emergence of resistance.