A Randomized Evaluation of Ethambutol for Prevention of Relapse and Drug Resistance during Treatment ofMycobacterium aviumComplex Bacteremia with Clarithromycin‐Based Combination Therapy | Zendy

Michael P. Dubé | Zendy; Fred R. Sattler | Zendy; Francesca J. Torriani | Zendy; Darryl M. See | Zendy; Diane V. Havlir | Zendy; Carol A. Kemper | Zendy; Massoud Dezfuli | Zendy; Samuel A. Bozzette | Zendy; Angie E. Bartok | Zendy; John M. Leedom | Zendy; Jeremiah G. Tilles | Zendy; J. Allen McCutchan | Zendy

Open Access

A Randomized Evaluation of Ethambutol for Prevention of Relapse and Drug Resistance during Treatment ofMycobacterium aviumComplex Bacteremia with Clarithromycin‐Based Combination Therapy

Author(s) -

Michael P. Dubé,

Fred R. Sattler,

Francesca J. Torriani,

Darryl M. See,

Diane V. Havlir,

Carol A. Kemper,

Massoud Dezfuli,

Samuel A. Bozzette,

Angie E. Bartok,

John M. Leedom,

Jeremiah G. Tilles,

J. Allen McCutchan

Publication year - 1997

Publication title -

the journal of infectious diseases

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 2.69

H-Index - 252

eISSN - 1537-6613

pISSN - 0022-1899

DOI - 10.1086/514116

Subject(s) - clarithromycin , ethambutol , bacteremia , medicine , clofazimine , randomized controlled trial , antibacterial agent , drug resistance , surgery , antibiotics , rifampicin , immunology , microbiology and biotechnology , tuberculosis , biology , pathology , leprosy , helicobacter pylori

Patients with AIDS and Mycobacterium avium complex (MAC) bacteremia are at high risk for relapse and emergence of resistant isolates during monotherapy with clarithromycin. Ninety-five AIDS patients with MAC bacteremia received clarithromycin plus clofazimine, with or without ethambutol, in a prospective, multicenter, randomized open-label trial. Of 80 patients with positive baseline cultures, sterilization or a 2 log10 reduction in colony-forming units of MAC in two consecutive blood cultures occurred in 69% of both groups. There were nine relapses in the two-drug arm and three in the three-drug arm. Kaplan-Meier estimates of risk of relapse at 36 weeks were 68% and 12%, respectively (P = .004). All relapse isolates were resistant to clarithromycin. Median time to clarithromycin resistance was 16 weeks with two drugs and 40 weeks with three drugs (P = .004). Ethambutol reduced relapses and emergence of clarithromycin resistance and should be considered an essential component of clarithromycin-based therapies for MAC bacteremia.

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