NEW TRENDS IN THE DRUG-THERAPY OF LOCALIZED AND DISSEMINATED MYCOBACTERIUM-AVIUM COMPLEX INFECTION

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.