Gp. Sesin et al., NEW TRENDS IN THE DRUG-THERAPY OF LOCALIZED AND DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX INFECTION, American journal of health-system pharmacy, 53(21), 1996, pp. 2585-2590
Recent advances in the drug therapy of localized and disseminated infe
ction with Mycobacterium avium complex (MAC) are reviewed. MAC infecti
on is the most commonly reported bacterial infection in patients with
AIDS, and the frequency of this infection in patients negative for the
human immunodeficiency virus (HIV) is increasing. The main portals of
entry for MAC are the gastrointestinal and respiratory tracts. Locali
zed MAC infection is more common in HIV-negative than HIV-infected pat
ients. The symptoms of disseminated MAC disease are those typical of a
dvanced HIV disease. The most reliable diagnosis is provided by blood
cultures; radiometric culturing techniques are favored. The overall tr
eatment of MAC infection has improved greatly with the introduction of
new agents during the past 15 years; survival time has been extended.
Clarithromycin and azithromycin have proven effective against both lo
calized and disseminated MAC infection. Clarithromycin is the cornerst
one of therapy for disseminated infection. Ciprofloxacin has been succ
essfully used to treat disseminated infection as part of a four-drug r
egimen including rifampin, ethambutol, and clofazimine. Rifabutin has
substantial efficacy when combined with other agents. Liposomal aminog
lycosides, such as amikacin, and interferon gamma have shown some init
ial promise. Rifabutin is currently recommended for the prevention of
MAC disease in HIV-infected patients. CIarithromycin and azithromycin
have also shown efficacy for prophylaxis, and fluoroquinolones may pla
y a preventive role as well. New drug therapies are improving the outl
ook for persons infected with MAC.