Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Clarithromycin and Other Antimicrobial Agents in the Treatment of Disseminated Mycobacterium avium Infections in Patients With Acquired Immunodeficiency Syndrome

Clarithromycin and Other Antimicrobial Agents in the Treatment of Disseminated Mycobacterium... Abstract Background: Disseminated infection with Mycobacterium avium is common with late-stage acquired immunodeficiency syndrome (AIDS), and no antimicrobial agent has been found to be clearly effective. Methods: A multicenter open trial was conducted to assess the antimicrobial activity and clinical efficacy of clarithromycin—a new macrolide antibiotic—against disseminated M avium in 77 patients with late-stage AIDS. Blood cultures were taken at baseline and during treatment; side effects were also evaluated. Results: Mycobacterium avium was eradicated from blood cultures in 11 (63%) of 16 evaluable patients receiving daily doses or 500 or 1000 mg, (n=21) and in 45 of 46 (98%) of those receiving 1500 or 2000 mg (n=56). Eradication after 2 months was influenced by continuity of drug treatment; 36 of 42 patients with no relapse had received continuous treatment vs six of 14 patients whose drug treatment had been stopped for 7 days or longer. After 2 to 7 months of treatment, acquired resistance associated with relapse was observed. Drug side effects were elevated liver enzyme levels (26%) and impaired hearing (4%). Concomitant AIDS drugs had no favorable effect on outcome and may have worsened liver toxicity. Conclusions: Clarithromycin has bacteriologic efficacy against M avium infection in late-stage AIDS, although drug resistance eventually develops. Further studies are needed to investigate safe, effective concomitant drugs.(Arch Intern Med. 1993;153:368-372) References 1. Wilkes MS, Fortin AH, Felix JC, Godwin TA, Thompson WG. Value of necropsy in acquired immunodeficiency syndrome . Lancet. 1988;2:85-88.Crossref 2. Wallace JM, Hannah JB. Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome: a clinicopathologic study . Chest. 1988;93:926-932.Crossref 3. American Thoracic Society and Centers for Disease Control. Mycobacterioses and the acquired immune deficiency syndrome: joint position paper . Am Rev Respir Dis. 1987;136:492-496.Crossref 4. Horsburgh CR, Selik RM. The epidemiology of disseminated nontuberculous mycobacterial infection in the acquired immune deficiency syndrome . Am Rev Respir Dis. 1989;139:4-7.Crossref 5. Chaisson RE, Hopewell PC. Mycobacteria and AIDS mortality . Am Rev Respir Dis. 1989;139:1-3.Crossref 6. Heifets LB, Iseman MD, Lindholm-Levy PJ. Combination of rifampin or rifabutine plus ethambutol against Mycobacterium avium complex: bactericidal synergistic, and bacteriostatic additive or synergistic effects . Am Rev Respir Dis. 1988;137:711-715.Crossref 7. Agins BD, Berman DS, Spicehandler D, El Sadr W, Simberkoff MS, Rahal JJ. Effect of combined therapy with ansamycin, clofazimine, ethambutol and isoniazid for Mycobacterium avium infection in patients with AIDS . J Infect Dis. 1989;159:784-787.Crossref 8. Hawkins CC, Gold JWM, Whimbey E, et al. Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome . Ann Intern Med. 1986;105:184-188.Crossref 9. Young LS. Mycobacterium avium complex infection . J Infect Dis. 1988;157: 863-867.Crossref 10. Hoy J, Mijch A. Sandlum M, Grayson L, Lucas R, Dwyer B. Quadruple-drug therapy for Mycobacterium avium intracellulare bacteremia in AIDS patients . J Infect Dis. 1990;161:801-805.Crossref 11. Chiu J, Nussbaum J, Bozzette S, et al. California Collaborative Treatment Group: treatment of disseminated Mycobacterium avium complex infection with amikacin, ethambutol, rifampin, and ciprofloxacin . Ann Intern Med. 1990;113:358-361.Crossref 12. Young LS, Wiviott L, Wu M, Kolonosky P, Inderlied CB, Bolan R. Azithromycin reduces M avium complex (MAC) bacteria and relieves its symptoms in patients with AIDS . In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 9, 1991 ; Chicago, III. Abstract 293. 13. Dautzenberg B, Truffot C, Mignon A, et al. Rifabutin in combination with clofazimine, isoniazid, and ethambutol in the treatment of AIDS patients with infections due to opportunistic mycobacteria . Tubercle . 1991;72:168-175.Crossref 14. Dautzenberg B, Truffot C, Legris S, et al. Activity of clarithromycin against Mycobacterium avium infection in patients with the acquired immune deficiency syndrome . Am Rev Respir Dis. 1991;144:564-569.Crossref 15. Fernandes PB, Hardy DJ, McDaniel D, Hanson CW, Swanson RN. In vitro and in vivo activities of clarithromycin against Mycobacterium avium . Antimicrob Agents Chemother. 1989;33:1531-1534.Crossref 16. Perrone C, Gikas A, Truffot-Pernot C, Grosset J, Pociadalo JJ, Vilde JL. Clarithromycin, sulfisoxasole and rifambutin activity against Mycobacterium avium complex multiplication within human macrophages . Antimicrob Agents Chemother. 1990;34:1508-1511.Crossref 17. Ji B, Lounis N, Truffot-Pernot C, Grosset JH. Susceptibility of the immunocompetent, beige, and nude mice to Mycobacterium avium infection and iresponse to clarithromycin . In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 9, 1991 ; Chicago, III. Abstract 291. 18. Klemens SP, Destefano MS, Cynamon MH. Clarithromycin in combination with other agents against M avium complex (MAC) in beige mice . In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 9, 1991 ; Chicago, Ill. Abstract 292. 19. Truffot-Pernot C, Lecoeur H, Maury L, Dautzenberg B, Grosset J. Results of blood cultures for detection of mycobacteria in AIDS patients . Tubercle. 1989; 70:187-191.Crossref 20. Truffot CH, Ji B, Grosset J. Effect of pH on in vitro potency of clarithromycin against M avium complex . Antimicrob Agents Chemother. 1991;35:1677-1678.Crossref 21. British Medical Research Council. Investigation of streptomycin in the treatment of pulmonary tuberculosis . BMJ. 1948;2:769-782.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Clarithromycin and Other Antimicrobial Agents in the Treatment of Disseminated Mycobacterium avium Infections in Patients With Acquired Immunodeficiency Syndrome

Download PDF
5 pages

Loading next page...
 
/lp/american-medical-association/clarithromycin-and-other-antimicrobial-agents-in-the-treatment-of-0sxo1gxcqJ

References (23)

Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1993.00410030074010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Disseminated infection with Mycobacterium avium is common with late-stage acquired immunodeficiency syndrome (AIDS), and no antimicrobial agent has been found to be clearly effective. Methods: A multicenter open trial was conducted to assess the antimicrobial activity and clinical efficacy of clarithromycin—a new macrolide antibiotic—against disseminated M avium in 77 patients with late-stage AIDS. Blood cultures were taken at baseline and during treatment; side effects were also evaluated. Results: Mycobacterium avium was eradicated from blood cultures in 11 (63%) of 16 evaluable patients receiving daily doses or 500 or 1000 mg, (n=21) and in 45 of 46 (98%) of those receiving 1500 or 2000 mg (n=56). Eradication after 2 months was influenced by continuity of drug treatment; 36 of 42 patients with no relapse had received continuous treatment vs six of 14 patients whose drug treatment had been stopped for 7 days or longer. After 2 to 7 months of treatment, acquired resistance associated with relapse was observed. Drug side effects were elevated liver enzyme levels (26%) and impaired hearing (4%). Concomitant AIDS drugs had no favorable effect on outcome and may have worsened liver toxicity. Conclusions: Clarithromycin has bacteriologic efficacy against M avium infection in late-stage AIDS, although drug resistance eventually develops. Further studies are needed to investigate safe, effective concomitant drugs.(Arch Intern Med. 1993;153:368-372) References 1. Wilkes MS, Fortin AH, Felix JC, Godwin TA, Thompson WG. Value of necropsy in acquired immunodeficiency syndrome . Lancet. 1988;2:85-88.Crossref 2. Wallace JM, Hannah JB. Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome: a clinicopathologic study . Chest. 1988;93:926-932.Crossref 3. American Thoracic Society and Centers for Disease Control. Mycobacterioses and the acquired immune deficiency syndrome: joint position paper . Am Rev Respir Dis. 1987;136:492-496.Crossref 4. Horsburgh CR, Selik RM. The epidemiology of disseminated nontuberculous mycobacterial infection in the acquired immune deficiency syndrome . Am Rev Respir Dis. 1989;139:4-7.Crossref 5. Chaisson RE, Hopewell PC. Mycobacteria and AIDS mortality . Am Rev Respir Dis. 1989;139:1-3.Crossref 6. Heifets LB, Iseman MD, Lindholm-Levy PJ. Combination of rifampin or rifabutine plus ethambutol against Mycobacterium avium complex: bactericidal synergistic, and bacteriostatic additive or synergistic effects . Am Rev Respir Dis. 1988;137:711-715.Crossref 7. Agins BD, Berman DS, Spicehandler D, El Sadr W, Simberkoff MS, Rahal JJ. Effect of combined therapy with ansamycin, clofazimine, ethambutol and isoniazid for Mycobacterium avium infection in patients with AIDS . J Infect Dis. 1989;159:784-787.Crossref 8. Hawkins CC, Gold JWM, Whimbey E, et al. Mycobacterium avium complex infections in patients with the acquired immunodeficiency syndrome . Ann Intern Med. 1986;105:184-188.Crossref 9. Young LS. Mycobacterium avium complex infection . J Infect Dis. 1988;157: 863-867.Crossref 10. Hoy J, Mijch A. Sandlum M, Grayson L, Lucas R, Dwyer B. Quadruple-drug therapy for Mycobacterium avium intracellulare bacteremia in AIDS patients . J Infect Dis. 1990;161:801-805.Crossref 11. Chiu J, Nussbaum J, Bozzette S, et al. California Collaborative Treatment Group: treatment of disseminated Mycobacterium avium complex infection with amikacin, ethambutol, rifampin, and ciprofloxacin . Ann Intern Med. 1990;113:358-361.Crossref 12. Young LS, Wiviott L, Wu M, Kolonosky P, Inderlied CB, Bolan R. Azithromycin reduces M avium complex (MAC) bacteria and relieves its symptoms in patients with AIDS . In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 9, 1991 ; Chicago, III. Abstract 293. 13. Dautzenberg B, Truffot C, Mignon A, et al. Rifabutin in combination with clofazimine, isoniazid, and ethambutol in the treatment of AIDS patients with infections due to opportunistic mycobacteria . Tubercle . 1991;72:168-175.Crossref 14. Dautzenberg B, Truffot C, Legris S, et al. Activity of clarithromycin against Mycobacterium avium infection in patients with the acquired immune deficiency syndrome . Am Rev Respir Dis. 1991;144:564-569.Crossref 15. Fernandes PB, Hardy DJ, McDaniel D, Hanson CW, Swanson RN. In vitro and in vivo activities of clarithromycin against Mycobacterium avium . Antimicrob Agents Chemother. 1989;33:1531-1534.Crossref 16. Perrone C, Gikas A, Truffot-Pernot C, Grosset J, Pociadalo JJ, Vilde JL. Clarithromycin, sulfisoxasole and rifambutin activity against Mycobacterium avium complex multiplication within human macrophages . Antimicrob Agents Chemother. 1990;34:1508-1511.Crossref 17. Ji B, Lounis N, Truffot-Pernot C, Grosset JH. Susceptibility of the immunocompetent, beige, and nude mice to Mycobacterium avium infection and iresponse to clarithromycin . In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 9, 1991 ; Chicago, III. Abstract 291. 18. Klemens SP, Destefano MS, Cynamon MH. Clarithromycin in combination with other agents against M avium complex (MAC) in beige mice . In: Program and abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 9, 1991 ; Chicago, Ill. Abstract 292. 19. Truffot-Pernot C, Lecoeur H, Maury L, Dautzenberg B, Grosset J. Results of blood cultures for detection of mycobacteria in AIDS patients . Tubercle. 1989; 70:187-191.Crossref 20. Truffot CH, Ji B, Grosset J. Effect of pH on in vitro potency of clarithromycin against M avium complex . Antimicrob Agents Chemother. 1991;35:1677-1678.Crossref 21. British Medical Research Council. Investigation of streptomycin in the treatment of pulmonary tuberculosis . BMJ. 1948;2:769-782.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Feb 8, 1993

There are no references for this article.