CLARITHROMYCIN THERAPY FOR MYCOBACTERIUM-AVIUM - COMPLEX INFECTIONS IN HIV-INFECTED PATIENTS

To assess the safety and efficacy of clarithromycin monotherapy of Myc obacterium avium-complex (MAC) infections in HIV-infected patients, we prospectively studied 22 consecutive patients with blood cultures pos itive for MAC. Quantitative MAC blood culture and clarithromycin susce ptibility tests were performed before and during therapy. Patients wer e randomly assigned to either 0.5 or 1 g of clarithromycin orally twic e daily, increased to 1 or 2 g orally twice daily if there was not a g ood clinical and microbiologic response after 1 month of therapy. One- third of patients died during the first 2 months of treatment. Survivo rs showed clinical improvement. Eight of 22 patients experienced nause a, vomiting, or diarrhea, which resulted in cessation of clarithromyci n therapy in four patients. All six MAC isolates obtained after more t han 2 months of therapy were resistant to clarithromycin. Nine of 22 p atients survived 4 and 6 months after initiation of therapy, but all d ied of AIDS-related conditions within 300 days. Two-thirds of MAC-infe cted patients responded to clarithromycin monotherapy, but resistance to clarithromycin emerged in those treated for more than 2 months, and mean survival was only 130 days. Multidrug regimens including clarith romycin need evaluation to determine whether survival and quality of l ife are improved, the emergence of resistance is prevented, and advers e drug effects are tolerable.