Summary
In a randomized double-blind study, nine mycobacteremic patients with AIDS-related disseminatedMycobacterium avium complex (MAC) infection received clarithromycin or placebo in addition to a basic regimen that included isoniazid, ethambutol and clofazimine. All four patients receiving clarithromycin showed blood culture conversion and clinical response. Of the five patients treated without clarithromycin, two showed resolution of mycobacteremia and clinical reponse, while another two died without having shown response. The remaining patient deteriorated until a switch from placebo to clarithromycin led to blood culture conversion and rapid clinical improvement. After finishing six weeks of intensive treatment, clarithromycin was given in an open maintenance phase to all patients, initially in combination with rifabutin for 24 weeks and then alone. One patient had a relapse of MAC infection while receiving clarithromycin alone. The relapse was associated with acquired resistance to the drug. Clarithromycin appears to be a promising component of multi-drug therapy for patients with MAC infection. Monotherapy can lead to drug resistance.
Zusammenfassung
Neun AIDS-Patienten mit disseminierterMycobacterium avium complex (MAC)-Infektion wurden in einer randomisierten Doppelblind-Studie mit Clarithromycin oder Plazebo behandelt, die zu einer Basiskombination aus Isoniazid, Ethambutol und Clofazimine hinzugegeben wurden. Alle vier mit Clarithromycin behandelten Patienten sprachen auf die Therapie an. Von fünf ohne Clarithromycin behandelten Patienten sprachen zwei auf die Therapie an, während zwei andere ohne Therapieeffekt verstarben. Ein Patient verschlechterte sich kontinuierlich, bis der Austausch von Plazebo gegen Clarithromycin zur Blutkultur-Konversion und Rückbildung von Krankheitserscheinungen führte. Nach einer sechswöchigen Akuttherapie-Phase erhielten alle Patienten Clarithromycin in einer offenen Studie zur Rezidiv-Prophylaxe, zunächst in Kombination mit Rifabutin für 24 Wochen und anschließend als Monotherapie. Ein Patient hatte ein Rezidiv der MAC-Infektion, das in der Monotherapie-Phase auftrat und mit einer erworbenen Resistenz gegen das Medikament assoziiert war. Clarithromycin ist eine vielversprechende Substanz für ein Kombinationsregime zur Behandlung der MAC-Infektion. Eine Monotherapie kann zur Resistenz-Entwicklung führen.
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Ruf, B., Schürmann, D., Pohle, H.D. et al. Effectiveness of the macrolide clarithromycin in the treatment ofMycobacterium avium complex infection in HIV-infected patients. Infection 20, 267–272 (1992). https://doi.org/10.1007/BF01710792
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DOI: https://doi.org/10.1007/BF01710792