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Clarithromycin, Rifabutin and Clofazimine for Treatment of Disseminated Mycobacterium avium Complex Disease in AIDS Patients

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Abstract

Objective: To evaluate the efficacy and tolerability of clarithromycin plus rifabutin plus clofazimine for the treatment of disseminated Mycobacterium avium complex (MAC) disease in patients with AIDS.

Design: Prospective, open-label, non-randomised study.

Setting: Tertiary care university hospital.

Patients: Thirty consecutive HIV-infected patients with disseminated MAC disease.

Interventions: Patients received the combination of clarithromycin (1000mg twice daily for the first 2 months and 500mg twice daily thereafter), rifabutin (450mg daily), and clofazimine (100mg daily), and were followed up for up to 1 year microbiologically and clinically.

Results: Among the 30 enrolled patients with a median CD4 count of 15/mm3 (range: 0 to 90/mm3) and a positive blood culture for MAC, 23 patients were evaluable for efficacy with a treatment duration of at least 4 weeks. Clinical improvement occurred in 13 (57%) patients within the first month. During the study duration of up to 12 months, 19 (83%) patients achieved a clinical response that was complete in 11 of them. Sterilisation of blood cultures was accomplished in 15 (65%) of the 23 patients. No cases of uveitis occurred during the total treatment duration of 141 patient months. Resistance to clarithromycin developed after a median time of 5.4 months (range: 3.1 to 10.4 months) in six (50%) of 12 patients who had positive blood cultures during treatment.

Conclusions: Although the combination regimen did not prevent development of clarithromycin resistance over long-term observation, our results confirm the activity of a clarithromycin- and rifabutin-containing regimen for the treatment of disseminated MAC disease in AIDS patients.

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Authors and Affiliations

  1. Division of Infectious Diseases and Hospital Epidemiology, Department of Medicine, University Hospital, CH-8091, Zurich, Switzerland

    Mark Haefner, Ruedi Lüthy &  Milos Opravil

  2. Swiss National Center for Mycobacteria, Department of Medical Microbiology, University of Zurich, Zurich, Switzerland

    Pascale Funke-Kissling & Gaby E. Pfyffer

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  1. Mark Haefner
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  2. Pascale Funke-Kissling
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  3. Gaby E. Pfyffer
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  4. Ruedi Lüthy
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  5. Milos Opravil
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Correspondence to Milos Opravil.

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Haefner, M., Funke-Kissling, P., Pfyffer, G.E. et al. Clarithromycin, Rifabutin and Clofazimine for Treatment of Disseminated Mycobacterium avium Complex Disease in AIDS Patients. Clin. Drug Investig. 17, 171–178 (1999). https://doi.org/10.2165/00044011-199917030-00001

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