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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.

the journal of infectious diseases (online. university of chicago press)/the journal of infectious diseases

A Randomized Evaluation of Ethambutol for Prevention of Relapse and Drug Resistance during Treatment of<i>Mycobacterium avium</i>Complex Bacteremia with Clarithromycin‐Based Combination Therapy

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