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  • Title: MAC management.
    Journal: PI Perspect; 1996 Nov; (No 20):16-7. PubMed ID: 11363967.
    Abstract:
    Results from recent studies are shedding light on ways to prevent and treat Mycobacterium avium Complex (MAC) disease, a leading cause of death for people with AIDS. A two-drug combination treatment appears to be best. The Food and Drug Administration (FDA) has approved three drugs for the treatment of MAC disease: rifabutin (Mycobutin), clarithromycin (Biaxin), and azithromycin (Zithromax). Two studies using clarithromycin show promising results and indicate that clarithromycin is superior to rifabutin. Another study comparing azithromycin to rifabutin and then to a combination of the two showed azithromycin to be comparable to rifabutin, and the combination was significantly better than either drug alone. Other data show both rifabutin and clarithromycin have drug interactions with some, if not all, of the available protease inhibitors. Azithromycin has no known drug interactions with protease inhibitors and may be attractive for those taking a protease inhibitor. Many drug interactions are appearing so patients need to use caution when using rifabutin. Studies have shown that the optimum treatment for MAC disease is clarithromycin and ethambutol; the addition of clofazimine does not result in any additional benefit. Higher doses of clarithromycin (1000 mg twice a day) over the approved dose levels have proven to be life-threatening. Although the MAC treatment recommendations are to use either azithromycin or clarithromycin with ethambutol, azithromycin is not approved by the FDA for this use, despite many physicians' beliefs that azithromycin is as effective as clarithromycin for treating MAC.
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