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(Drug information on 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%).