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[Mycobacterium avium intracellulare infections. Treatment with a clarithromycin-clofazimine combination. 18 cases]
T Saint-Marc1, E Marneff, J L Touraine
1Service de Transplantation et d'Immunologie clinique, Hôpital Edouard Herriot, Lyon.
Abstract:
Infections caused by Mycobacterium avium intracellulare have become worrying because of their higher frequency, their new tendency to diffuse in all tissues (notably the blood) and the lack of curative treatment. The mortality rate remains high and the survival of patients after AIDS is diagnosed is estimated at 7.4 months. The effectiveness of new antimycobacterial drugs, observed in experiments on beige mice, has not yet been confirmed. In 18 patients suffering from this infection, either disseminated (88 percent) or localized in the lung (12 percent), a 12-week treatment with the clarithromycin-clofazimine combination has succeeded in sterilizing the pathological samples. Most patients reported a distinct improvement in their general condition, with fall of temperature, disappearance of most other symptoms, weight gain and better quality of life. Treatment was interrupted in 1 patient owing to liver toxicity. In this study the median survival of the patients after the Mycobacterium avium complex has been estimated at 11.4 months after the diagnosis of AIDS at 28.9 months.
Insights
A clarithromycin-clofazimine combination effectively treated Mycobacterium avium complex infections in AIDS patients, sterilizing samples and improving quality of life. This treatment extended median survival compared to previous estimates.
Area of Science:
- Infectious Diseases
- Microbiology
- Pulmonology
Background:
- Mycobacterium avium intracellulare infections are increasingly prevalent and disseminated.
- These infections have a high mortality rate, especially in AIDS patients, with limited curative options.
- Previous experimental drug efficacy in mice has not translated to human clinical success.
Purpose of the Study:
- To evaluate the efficacy of a clarithromycin-clofazimine combination in treating Mycobacterium avium complex (MAC) infections.
- To assess the impact of this treatment on patient survival and quality of life.
Main Methods:
- A 12-week treatment regimen using clarithromycin and clofazimine was administered to 18 patients with MAC infection.
- Patients had either disseminated MAC (88%) or pulmonary MAC (12%).
- Pathological samples were analyzed for sterilization, and patient clinical status, including survival, was monitored.
Main Results:
- The clarithromycin-clofazimine combination successfully sterilized pathological samples in all treated patients.
- Most patients experienced significant clinical improvement, including reduced fever, symptom resolution, weight gain, and enhanced quality of life.
- Median survival was estimated at 11.4 months post-AIDS diagnosis, an improvement over the 7.4 months previously reported. One patient discontinued treatment due to liver toxicity.
Conclusions:
- The clarithromycin-clofazimine combination is an effective treatment for Mycobacterium avium complex infections in AIDS patients.
- This regimen demonstrates potential for improving clinical outcomes and extending survival in this patient population.
- Further research is warranted to confirm these findings and optimize treatment strategies.