CLARITHROMYCIN - A REVIEW OF ITS PHARMACOLOGICAL PROPERTIES AND THERAPEUTIC USE IN MYCOBACTERIUM-AVIUM-INTRACELLULARE COMPLEX INFECTION IN PATIENTS WITH ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME

Results from noncomparative and placebo-controlled studies demonstrate the efficacy of clarithromycin in the treatment of disseminated Mycob acterium avium-intracellulare complex (MAC) infection in patients with acquired immune deficiency syndrome (AIDS), Whether given alone or in combination with other antimycobacterial treatments, doses of 500 to 2000mg (typically 1000mg) administered twice daily are effective in co ntrolling bacteraemia in these patients. Clarithromycin has also been shown to improve clinical symptoms of infection and may improve qualit y of life in AIDS patients with MAC infection. Clarithromycin is gener ally well tolerated when used in the doses typically required for the treatment of MAC infection (1000 or 2000 mg/day). Gastrointestinal dis turbances are the most commonly occurring adverse events and occur mos t frequently at dosages of 4000 mg/day. Thus, clarithromycin, as monot herapy or in combination with other antimycobacterial agents, is well tolerated and effectively eradicates MAC from the blood in the short t erm in patients with AIDS; however, short term monotherapy may lead to bacterial resistance, underscoring the importance of long term treatm ent with a combination of antimycobacterial agents. While the optimal combination regimen to prevent the development of resistance to antimy cobacterial agents by MAC remains to be determined, clarithromycin wil l almost certainly be a valuable agent in any such combination.