Mycobacterium avium Complex Infection

Mycobacterium avium Complex Infection is a topic covered in the Washington Manual of Medical Therapeutics.

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  • Initial therapy should include a macrolide (i.e., clarithromycin, 500 mg PO bid) and ethambutol, 15 mg/kg PO daily.
  • Rifabutin, 300 mg PO daily, an aminoglycoside 10–15 mg/kg IV daily, or a fluoroquinolone can be added in severe cases or patients not on effective ART, and based on sensitivities.
  • Utility of disseminated MAC prophylaxis is currently under debate given prophylaxis toxicity and effectiveness of modern ART. The US Department of Health and Human Services continues to recommend primary prophylaxis, but the International Antiviral Society of USA recommends against primary prophylaxis if effective ART is initiated immediately and viral suppression achieved (AIIa recommendation).
  • Secondary prophylaxis for disseminated MAC can be discontinued if the CD4 count has a sustained increase of >100 cells/μL for 6 months or longer in response to ART, and if 12 months of therapy for MAC is completed and there are no symptoms or signs attributable to MAC.

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