From the Guidelines
Yes, Azithromycin is given as Mycobacterium Avium Complex (MAC) prophylaxis to HIV patients with severe immunosuppression (CD4 count less than 50).
Key Points
- The preferred prophylactic agents for MAC disease are clarithromycin or azithromycin 1.
- Azithromycin is recommended as a prophylactic agent due to its efficacy and ease of use, with a dose of 1,200 mg 1.
- Before initiating prophylaxis, disseminated MAC disease should be ruled out by clinical assessment, which may include obtaining a blood culture for MAC if warranted 1.
- Rifabutin is an alternative prophylactic agent for MAC disease if azithromycin or clarithromycin cannot be tolerated, but its use is complicated by potential drug interactions 1.
- The combination of azithromycin with rifabutin is more effective than azithromycin alone, but the additional cost, increased occurrence of adverse effects, and absence of a survival difference do not warrant a routine recommendation for this regimen 1.
Considerations
- Tolerance, cost, and drug interactions are important considerations in decisions regarding the choice of prophylactic agents for MAC disease 1.
- Particular attention should be paid to interactions with antiretroviral protease inhibitors and nonnucleoside reverse transcriptase inhibitors 1.
From the Research
Azithromycin as MAC Prophylaxis
- Azithromycin is given as Mycobacterium Avium Complex (MAC) prophylaxis to HIV patients with severe immunosuppression (CD4 count less than 50) 2, 3.
- A study published in 1998 found that azithromycin (1,200 mg once weekly) was effective in preventing MAC infection in patients with AIDS and a CD4 cell count of < 100/mm3 4.
- The same study found that azithromycin reduced the risk of MAC infection by 65% and the risk of death due to MAC infection by 69% 4.
- Another study published in 2004 found that prophylaxis with azithromycin or clarithromycin is recommended for all patients with CD4 counts less than 50 cells/mL 3.
Treatment and Prophylaxis Guidelines
- Treatment regimens for patients with a positive culture for MAC from a sterile site should include two or more drugs, including clarithromycin 2.
- Prophylaxis against disseminated MAC should be considered for patients with a CD4 cell count of less than 50/mm3 2, 3.
- Optimum treatment for disseminated MAC includes clarithromycin and ethambutol, and another investigation suggests that the addition of rifabutin might reduce mortality 3.
Resistance and Discontinuation of Prophylaxis
- A study published in 2001 found that macrolide resistance was present in the respiratory flora of HIV-infected patients receiving either clarithromycin or azithromycin for MAC prophylaxis 5.
- The study suggests that the observed high incidence of macrolide-resistant bacterial colonization of the respiratory tract supports the discontinuation of macrolide prophylaxis in all AIDS patients whose CD4 counts have risen above 100 cells/microL 5.