MYCOBACTERIUM-AVIUM COMPLEX - ADVANCES IN THERAPY

Disseminated Mycobacterium avium complex (MAC) is one of the most comm on opportunistic infections in AIDS patients and is increasingly recog nized as a significant pathogen in chronic pulmonary disease in nonimm unocompromised patients. Important progress in therapy has occurred ov er the last several years. In AIDS patients, multidrug therapy has bee n shown to be beneficial in terms of reducing circulating bacteremia a nd improving clinical symptoms. Clarithromycin and azithromycin, two b road-spectrum antimicrobials with minimal activity against Mycobacteri um tuberculosis, have emerged as potent, well tolerated agents pivotal to treatment regimens. In AIDS patients, rifabutin prophylaxis reduce d the frequency of MAC bacteremia by 50 % in two placebo controlled tr ials. Despite these advances, there remains a need for determining the optimal combination regimens for therapy, and more effective drugs fo r prophylaxis which are beneficial both in terms of survival and funct ional capacity of patients.