Azithromycin as treatment for disseminated Mycobacterium avium complex in AIDS patients

• Published in: Antimicrobial agents and chemotherapy Vol. 43; no. 12; pp. 2869 - 2872
• Main Authors: KOLETAR, S. L, BERRY, A. J, CYNAMON, M. H, JACOBSON, J, CURRIER, J. S, MACGREGOR, R. R, DUNNE, M. W, WILLIAMS, D. J
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society for Microbiology 01.12.1999
• Subjects: Adult; AIDS-Related Opportunistic Infections - drug therapy; AIDS-Related Opportunistic Infections - microbiology; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Azithromycin - therapeutic use; Biological and medical sciences; Clinical Therapeutics; Female; Human immunodeficiency virus 1; Humans; Male; Medical sciences; Middle Aged; Mycobacterium avium; Mycobacterium avium-intracellulare Infection - blood; Mycobacterium avium-intracellulare Infection - drug therapy; Mycobacterium avium-intracellulare Infection - microbiology; Pharmacology. Drug treatments; Human; Immunopathology; Toxicity; Multicenter study; Azithromycin; Oral administration; Mycobacterium avium; AIDS; Immune deficiency; Macrolide; Infection; Antibiotic; Chemotherapy; Randomization; Treatment; Mycobacteriales; Viral disease; Mycobacteriaceae; Bacteriosis; Bacteria; Actinomycetes; Antibacterial agent
• ISSN: 0066-4804; 1098-6596
• DOI: 10.1128/aac.43.12.2869

This multicenter, randomized, dose-ranging study was performed to determine the safety and efficacy of two different doses of azithromycin for treating disseminated Mycobacterium avium complex (MAC) in patients with AIDS. Eighty-eight AIDS patients with symptoms and blood cultures consistent with disseminated MAC were treated with 600 or 1,200 mg of azithromycin daily for 6 weeks; 62 patients completed the entire 6 weeks of study. Of note, this study was done prior to the time when combination antiretroviral or anti-MAC regimens were the standard of care. Over the 6-week study period, symptomatic improvement was noted in both dose groups. Microbiological responses were comparable, with mean decreases of 1. 5 and 2.0 log CFU/ml in the high- and low-dose groups, respectively. Sterilization of blood cultures occurred in 54% of samples; patients with lower baseline colony counts were more likely to achieve culture negativity. Resistance developed in one patient. Gastrointestinal symptoms were the most common side effects and were more frequent in patients receiving 1,200 mg. Azithromycin is a useful alternative treatment for disseminated MAC infection in AIDS patients. Symptomatic improvement correlates with measurable decreases in mycobacterial load.