Azithromycin as treatment for disseminated Mycobacterium avium complex in AIDS patients

This multicenter, randomized, dose-ranging study was performed to determine the safety and efficacy of two different doses of azithromycin for treatin g disseminated Mycobacterium avium complex (MAC) in patients with AIDS. Eig hty-eight AIDS patients with symptoms and blood cultures consistent with di sseminated MAC were treated with 600 or 1,200 mg of azithromycin daily for 6 weeks; 62 patients completed the entire 6 weeks of study, Of note, this s tudy was done prior to the time when combination antiretroviral or anti-MAC regimens were the standard of care. Over the 6-week study period, symptoma tic improvement was noted in both dose groups, Microbiological responses we re comparable, with mean decreases of 1.5 and 2.0 log CFU/ml in the high- a nd low-dose groups, respectively, Sterilization of blood cultures occurred in 54% of samples; patients with lower baseline colony counts were more lik ely to achieve culture negativity, Resistance developed in one patient. Gas trointestinal symptoms were the most common side effects and were more freq uent in patients receiving 1,200 mg. Azithromycin is a useful alternative t reatment for disseminated MAC infection in AIDS patients. Symptomatic impro vement correlates with measurable decreases in mycobacterial load.