From the Research
The recommended dose of azithromycin for Mycobacterium avium complex (MAC) infection when given three times weekly is 600 mg per dose, as part of a multidrug regimen that typically includes ethambutol and rifampin or rifabutin. This recommendation is based on the study by 1, which demonstrated the effectiveness of daily and three-times-weekly regimens containing azithromycin for treatment of MAC lung disease. The three-times-weekly regimen is generally used for less severe disease or as maintenance therapy after an initial daily treatment phase. Key points to consider in the treatment of MAC infections include:
- Treatment duration is typically long, often continuing for at least 12 months after culture conversion 2
- Azithromycin works by binding to the 50S ribosomal subunit of susceptible bacteria, inhibiting protein synthesis
- The extended half-life of azithromycin allows for the three-times-weekly dosing schedule while maintaining therapeutic levels
- Patients should be monitored for potential side effects including gastrointestinal disturbances, hearing loss, and QT interval prolongation 3
- Regular follow-up with sputum cultures is necessary to confirm treatment efficacy It's worth noting that more recent studies, such as 4, have emphasized the importance of adherence to guideline-based therapy and the need for alternative treatment options for patients who cannot tolerate standard regimens. However, the dose of azithromycin recommended in these studies is not explicitly stated, and therefore the study by 1 remains the most relevant to this specific question. Additionally, other studies such as 5 have discussed the diagnosis and treatment of MAC infections, but do not provide more recent or higher-quality evidence regarding the dose of azithromycin than the study by 1.