title: Prevention of disseminated Mycobacterium avium complex infection with reduced dose clarithromycin in patients with advanced HIV disease.
abstract: OBJECTIVE
  To evaluate the ability of once daily reduced dose clarithromycin to prevent disseminated Mycobacterium avium complex (dMAC) infection in patients with advanced HIV disease.
  
  
  METHODS
  Non-randomized, retrospective study.
  
  
  METHODS
  Outpatient clinic of an urban university-affiliated municipal hospital.
  
  
  METHODS
  A group of 192 HIV-infected patients with a CD4 count < 100 x 10(6) cells/l who were followed for at least 90 days during a 6-year period (1991-1996) before the use of protease inhibitors.
  
  
  METHODS
  Clarithromycin 500 mg orally once daily (n = 84), rifabutin 300 mg orally once daily (n = 47) or no prophylaxis (n = 61).
  
  
  METHODS
  Positive blood culture for M. avium complex (MAC), time to development of dMAC, and time to death.
  
  
  RESULTS
  When compared with no prophylaxis or rifabutin, the incidence of dMAC and time to development of dMAC were improved among those patients receiving clarithromycin (P < 0.001). Prolonged survival was associated with both clarithromycin and rifabutin use when compared with no prophylaxis (P < 0.002). In patients who failed prophylaxis, resistance to clarithromycin and rifabutin was observed.
  
  
  CONCLUSIONS
  In the era prior to protease inhibitor use, once daily clarithromycin at a dose of 500 mg was associated with a reduction in the incidence of dMAC, appeared to be superior to rifabutin, and was associated with prolonged survival in patients with advanced HIV disease.
authors.affiliation: Department of Medicine, State University of New York at Buffalo, USA.
authors.forename: R G
authors.initials: RG
authors.lastname: Hewitt
authors.forename: G D
authors.initials: GD
authors.lastname: Papandonatos
authors.forename: M J
authors.initials: MJ
authors.lastname: Shelton
authors.forename: C B
authors.initials: CB
authors.lastname: Hsiao
authors.forename: B J
authors.initials: BJ
authors.lastname: Harmon
authors.forename: S R
authors.initials: SR
authors.lastname: Kaczmarek
authors.forename: D
authors.initials: D
authors.lastname: Amsterdam
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality / Q000517:prevention & control*; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D000904:Antibiotics, Antitubercular / Q000494:pharmacology / Q000627:therapeutic use; D001769:Blood / Q000382:microbiology; D017291:Clarithromycin / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D015269:Mycobacterium avium Complex / Q000187:drug effects; D015270:Mycobacterium avium-intracellulare Infection / Q000517:prevention & control*; D012189:Retrospective Studies; D017828:Rifabutin / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular; D017828:Rifabutin; D017291:Clarithromycin