A comparison of two regimens for the treatment of Mycobacterium avium complex bacteremia in aids: Rifabutin, ethambutol, and clarithromycin versus rifampin, ethambutol, clofazimine, and ciprofloxacin

被引:221
作者
Shafran, SD
Singer, J
Zarowny, DP
Phillips, P
Salit, I
Walmsley, SL
Fong, IW
Gill, MJ
Rachlis, AR
Lalonde, RG
Fanning, MM
Tsoukas, CM
机构
[1] CANADIAN HIV TRIALS NETWORK,NATL CTR,VANCOUVER,BC,CANADA
[2] ST PAULS HOSP,DIV INFECT DIS,VANCOUVER,BC V6Z 1Y6,CANADA
[3] UNIV BRITISH COLUMBIA,VANCOUVER,BC V5Z 1M9,CANADA
[4] TORONTO HOSP,DIV INFECT DIS,TORONTO,ON M5T 2S8,CANADA
[5] UNIV TORONTO,TORONTO,ON,CANADA
[6] ST MICHAELS HOSP,DIV INFECT DIS,TORONTO,ON M5B 1W8,CANADA
[7] UNIV CALGARY,DIV INFECT DIS,CALGARY,AB,CANADA
[8] SUNNYBROOK HLTH SCI CTR,DIV INFECT DIS,TORONTO,ON M4N 3M5,CANADA
[9] MONTREAL CHEST INST,DIV INFECT DIS,MONTREAL,PQ,CANADA
[10] MCGILL UNIV,MONTREAL,PQ,CANADA
[11] UNIV TORONTO,WELLESLEY HOSP,DIV INFECT DIS,TORONTO,ON M4Y 1J3,CANADA
[12] MONTREAL GEN HOSP,DIV IMMUNOL,MONTREAL,PQ H3G 1A4,CANADA
关键词
ACQUIRED-IMMUNODEFICIENCY-SYNDROME; NATURAL-HISTORY; INFECTION; DISEASE; SURVIVAL; THERAPY; TRIALS;
D O I
10.1056/NEJM199608083350602
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Bacteremia with the Mycobacterium avium complex is common in patients with the acquired immunodeficiency syndrome (AIDS), but the most effective treatment for this infection remains unclear. Methods We randomly assigned 229 patients with AIDS and M. avium complex bacteremia to receive either rifampin (600 mg daily), ethambutol (approximately 15 mg per kilogram of body weight daily), clofazimine (100 mg daily), and ciprofloxacin (750 mg twice daily) (the four-drug group) or rifabutin (600 mg daily), ethambutol (as above), and clarithromycin (1000 mg twice daily) (the three-drug group). In the three-drug group the dose of rifabutin was reduced by half after 125 patients were randomized, because 24 of 63 patients had uveitis. Results Among 187 patients who could be evaluated, blood cultures became negative more often in the three-drug group than in the four-drug group (69 percent vs. 29 percent, P<0.001). Among patients treated for at least four weeks, the bacteremia resolved more frequently in the three-drug group (78 percent vs. 40 percent, P<0.001). In the three-drug group, bacteremia resolved more often with the 600-mg dose of rifabutin than with the 300-mg dose (P=0.025), but the latter regimen was more effective than the four-drug regimen (P<0.05). The median survival was 8.6 months in the three-drug group and 5.2 months in the four-drug group (P=0.001). The median Karnofsky performance score was higher in the three-drug group than in the four-drug group from week 2 to week 16 (P<0.05). Mild uveitis developed in 3 of the 53 patients receiving the 300-mg dose of rifabutin, an incidence about one quarter that observed with the 600-mg dose (P<0.001). Conclusions In patients with AIDS and M. avium complex bacteremia, treatment with the three-drug regimen of rifabutin, ethambutol, and clarithromycin leads to resolution of the bacteremia more frequently and more rapidly than treatment with rifampin, ethambutol, clofazimine, and ciprofloxacin, and survival rates are better. (C) 1996, Massachusetts Medical Society.
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收藏
页码:377 / 383
页数:7
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