Clarithromycin in the Treatment of Mycobacterium avium Lung Infections in Patients Without AIDS

Mycobacterium avium complex infections, common in patients with AIDS as either pulmonary or disseminated disease, are infrequent in patients without AIDS. Participants were 45 HIV-negative patients with lung disease and positive sputum cultures for M avium; 10 had documented immunocompromise, and 24 had preexisting lung disease. Clarithromycin dosage was 500 to 2,000 mg daily (mean ± SD=1,633 ± 432 mg). The drug was administered either alone (n=14) or in combination with rifampin (n=8), aminoglycoside (n=1), quinolone (n=10), clofazimine (n=18), isoniazid (n=5), ethambutol (n=9), pyrazinamide (n=1), or minocycline (n=6). At 3 months, 36 patients among 39 bacteriologically assessed had negative sputum cultures, 3 had positive culture, 3 were dead, and 3 discontinued treatment. At the end of treatment, 32 patients remained negative, 7 were positive. The success rate was 15 of 22 (64%) in patients previously treated with antimycobacterial drugs for M avium disease and 17 of 23 (74%) in new patients. Adverse effects included mild hearing loss (n=4), increase in liver enzyme levels (n=5), and gastrointestinal pain (n=10, two of whom had to stop treatment). Patients stopped treatment after 300 ± 186 days due to side effects (3), death (4), or the patient's (5) or physician's decision (33). During the follow-up, one patient suffered a relapse with peripheral lymph nodes. A daily dose of 30 mg/kg of clarithromycin in the treatment of M avium infections appears to be effective and safe. Concomitant drug therapy should be assessed for its ability to prevent relapse.