Ba. Brown et al., RELATIONSHIP OF ADVERSE EVENTS TO SERUM DRUG LEVELS IN PATIENTS RECEIVING HIGH-DOSE AZITHROMYCIN FOR MYCOBACTERIAL LUNG-DISEASE, Clinical infectious diseases, 24(5), 1997, pp. 958-964
We treated 39 elderly human immunodeficiency virus-noninfected patient
s with Mycobacterium avium complex and/or Mycobacterium abscessus lung
disease with azithromycin (600 mg daily), given initially as monother
apy. Adverse events occurred in 33 of 39 patients (85%) receiving azit
hromycin alone, most commonly gastrointestinal (GI) symptoms (32 of 39
, or 82%) and hearing impairment (10 of 39, or 26%). Twenty-four of 39
patients (62%) required a lower dose or withdrawal of the drug, The m
ean serum level in patients who required a dose reduction because of h
earing impairment was 0.8 +/- 0.4 mu g/mL, and that in patients whose
reduction was necessitated by GI symptoms was 0.7 +/- 0.4 mu g/mL; in
comparison, the mean serum level was 0.3 +/- 0.16 mu g/mL in patients
with no adverse events (P =.004 and .003, respectively). Decreasing th
e daily dose to 300 mg resulted in resolution of most adverse events.
Serum levels with monotherapy were comparable to levels after the addi
tion of other antituberculous drugs that included rifampin or rifabuti
n. Thus, a 300-mg rather than 600-mg daily dose of azithromycin is bet
ter tolerated by elderly patients, and serum levels appear unaffected
by other antituberculous agents, including rifampin.