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Clarithromycin Prophylaxis for MAC May Also Prevent PCP, Giardiasis

Clarithromycin Prophylaxis for MAC May Also Prevent PCP, Giardiasis

LISBON--Clarithromycin prophylaxis for Mycobacterium avium
complex (MAC) may provide additional benefits to AIDS patients
by preventing the development of common opportunistic infections,
Mark Pierce, MD, said at the Third International Conference on
the Macrolides, Azalides, and Streptogra-mins, sponsored by Abbott
Laboratories.

Clarithromycin (Biaxin), a macrolide antibiotic, is FDA approved
for the prevention and treatment of MAC.

The findings are from a multicenter double-blind trial in which
682 HIV-infected patients whose CD4 lymphocyte count was 100/mL
or less were randomized to clarithromycin, 500 mg twice daily,
or placebo, for the prevention of disseminated MAC infection,
said Dr. Pierce, principal investigator of the trial and director,
Infectious Diseases Clinic, Van-derbilt University School of Medicine.

In the study, patients were allowed to continue their current
prophylactic regimen for Pneumocystis carinii pneumonia
(PCP). Eighteen patients (5.3%) on cla-rithromycin prophylaxis
had a documented PCP episode vs 34 (10%) on placebo, a significant
difference.

Clarithromycin treatment was also associated with significantly
fewer episodes of community-acquired pneumonia: 24 episodes (7%)
in patients receiving cla-rithromycin prophylaxis, compared with
44 episodes (13%) in the placebo group.

Giardia lamblia, the bacterium responsible for giardiasis,
was observed in only three patients (0.9%) randomized to clarithromycin
vs 10 patients (2.9%) receiving placebo. Again, the difference
was significant. Clarithromycin-treated patients also experienced
fewer episodes of diarrhea than placebo-treated patients.

Clarithromycin was generally well tolerated, Dr. Pierce said.
The only adverse event that occurred significantly more often
in patients who received the mac-rolide was dysgeusia. The most
common side effects secondary to clarithromycin were abdominal
pain (3.2%), diarrhea (2.9%), flatulence (1.3%), headache (1.6%),
nausea (12.3%), rash (3.2%), dysgeusia (3.6%), and vomiting (7.5%).

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