RANDOMIZED, OPEN-LABEL TRIAL OF AZITHROMYCIN PLUS ETHAMBUTOL VS. CLARITHROMYCIN PLUS ETHAMBUTOL AS THERAPY FOR MYCOBACTERIUM-AVIUM COMPLEX BACTEREMIA IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Disseminated Mycobacterium avium complex (MAC) infection continues to be a common opportunistic infection in patients infected with human im munodeficiency virus (HIV). The optimal therapy for disseminated MAC i nfection is unclear, We compared azithromycin plus ethambutol with cla rithromycin plus ethambutol in the treatment of disseminated MAC infec tion in HIV type 1-infected patients, examining the frequency of bacte remia clearance, time to clearance, and study drug tolerance after 16 weeks of therapy. Fifty-nine patients for whom blood cultures were pos itive for MAC were enrolled in the study from 10 university-affiliated Veterans Affairs Medical Centers. Thirty-seven patients were evaluabl e for determination of quantitative bacteremia and clinical outcomes. Clearance of bacteremia was seen at the final visit in 37.5% of azithr omycin-treated patients and in 85.7% of clarithromycin-heated patients (P = .007). The estimated median time to clearance of bacteremia was also significantly different between the two treatment arms: 4.38 week s for clarithromycin recipients vs. >16 weeks for azithromycin recipie nts (P = .0018). Only one isolate developed macrolide resistance durin g therapy. Abatement of symptoms, other laboratory-evident abnormaliti es, and adverse effects were similar in the two groups. At the doses u sed in this study, clarithromycin/ethambutol produced a more rapid res olution of bacteremia than did azithromycin/ethambutol, and clarithrom ycin/ethambutol was more effective at sterilization of blood cultures after 16 weeks of therapy.