par Dautzenberg, Bertrand;Grosset, Jacques Henri J.;Saint-Marc, Thierry;Meyohas, Marie Caroline;Eliaszewitch, M.;Haniez, F.;Rogues, Anne Marie;De Wit, Stéphane ;Cotte, Laurent;Chauvin, Jean Pierre
Référence Archives of internal medicine, 153, 3, page (368-372)
Publication Publié, 1993-02
Référence Archives of internal medicine, 153, 3, page (368-372)
Publication Publié, 1993-02
Article révisé par les pairs
Résumé : | Background: Disseminated infection with Mycobacterium avium is common with late-stage acquired immunodeficiency syndrome (AIDS), and no antimicrobial agent has been found to be clearly effective. Methods: A multicenter open trial was conducted to assess the antimicrobial activity and clinical efficacy of clarithromycin - a new macrolide antibiotic - against disseminated Mavium in 77 patients with late-stage AIDS. Blood cultures were taken at baseline and during treatment; side effects were also evaluated. Results: Mycobacterium avium was eradicated from blood cultures in 11 (63%) of 16 evaluable patients receiving daily doses or 500 or 1000 mg, (n=21) and in 45 of 46 (98%) of those receiving 1500 or 2000 mg (n=56). Eradication after 2 months was influenced by continuity of drug treatment; 36 of 42 patients with no relapse had received continuous treatment vs six of 14 patients whose drug treatment had been stopped for 7 days or longer. After 2 to 7 months of treatment, acquired resistance associated with relapse was observed. Drug side effects were elevated liver enzyme levels (26%) and impaired hearing (4%). Concomitant AIDS drugs had no favorable effect on outcome and may have worsened liver toxicity. Conclusions: Clarithromycin has bacteriologic efficacy against M avium infection in late-stage AIDS, although drug resistance eventually develops. Further studies are needed to investigate safe, effective concomitant drugs. |