Treatment of Mycobacterium avium Complex Bacteremia in AIDS with a Four-Drug Oral Regimen
- 15 March 1992
- journal article
- clinical trial
- Published by American College of Physicians in Annals of Internal Medicine
- Vol. 116 (6), 466-472
- https://doi.org/10.7326/0003-4819-116-6-466
Abstract
▪ Objective: To determine the quantitative microbiologic response and the clinical response of patients with Mycobacterium avium complex bacteremia and AIDS to an oral antimycobacterial regimen. ▪ Design: A phase II, multicenter clinical trial. ▪ Setting: Four university-affiliated medical centers. ▪ Patients: Forty-one patients with HIV infection who had at least two consecutive blood cultures positive for M. avium complex and who had not received previous antimycobacterial therapy were enrolled in the study. Thirty-one patients were valuable with regard to the efficacy of the oral regimen. ▪ Interventions: Patients received a combination of orally administered rifampin (600 mg), ethambutol (15 mg/kg body weight), clofazimine (100 mg once daily), and ciprofloxacin (750 mg twice daily) for 12 weeks. Parenterally administered amikacin, 7.5 mg/kg daily for 4 weeks after the first 4 weeks of oral therapy, was used at the discretion of the individual investigator. ▪ Measurements: Clinical symptoms, Karnofsky scores, and adverse events were monitored. Colony counts for M. avium complex were determined. ▪ Main Results: The mean logarithmic (log) baseline colony count decreased from 2.1 to 0.7 after 4 weeks of oral therapy (P < 0.001). Suppression of bacteremia was sustained throughout therapy. Thirteen patients (42%) became culture negative during therapy. The mean duration of treatment was 9.7 weeks. Nineteen evaluable patients (61%) completed 12 weeks of therapy. Adverse reactions to one or more agents were common. ▪ Conclusions: A rapid reduction in symptoms and bacteremia can be achieved as early as week 2 of therapy using an oral regimen of rifampin, ethambutol, clofazimine, and ciprofloxacin. Colony counts rose dramaticallyafter therapy was discontinued, suggesting that more prolonged periods of therapy are necessary to eradicate systemic infection.Keywords
This publication has 15 references indexed in Scilit:
- Mycobacterium aviumComplex Infection in the Acquired Immunodeficiency SyndromeNew England Journal of Medicine, 1991
- Treatment of Tuberculosis in Patients with Advanced Human Immunodeficiency Virus InfectionNew England Journal of Medicine, 1991
- Quadruple-Drug Therapy for Mycobacterium avium-intracellulare Bacteremia in AIDS PatientsThe Journal of Infectious Diseases, 1990
- Treating Disseminated Mycobacterium avium-intracellulare InfectionAnnals of Internal Medicine, 1989
- Clofazimine and other rimino-compounds: Minimal inhibitory and minimal bactericidal concentrations at different pHs for mycobacterium avium complexTubercle, 1988
- Mycobacterium avium Complex Infection in Patients with the Acquired Immunodeficiency SyndromeChest, 1988
- Mycobacterium avium Complex InfectionThe Journal of Infectious Diseases, 1988
- Effect of Combined Clofazimine and Ansamycin Therapy on Mycobacterium avium--Mycobacterium intracellulare Bacteremia in Patients with AIDSThe Journal of Infectious Diseases, 1987
- Mycobacterium avium-M. intracellulare isolates from patients with or without acquired immunodeficiency syndromeAntimicrobial Agents and Chemotherapy, 1986
- Continuous high-grade mycobacterium avium-intracellulare bacteremia in patients with the acquired immune deficiency syndromeAmerican Journal Of Medicine, 1985