LETTER
Clarithromycin Therapy for Mycobacterium avium Complex Bacteremia
Nina Singh and
Victor L. Yu
15 July 1995 | Volume 123 Issue 2 | Pages 154-155
TO THE EDITOR:
In the report of the dose-ranging trial of clarithromycin for bacteremic Mycobacterium avium complex disease in patients with human immunodeficiency virus (HIV) infection, Chaisson and colleagues [1] reported that despite significantly faster sterilization of the blood stream and a significantly greater clinical response with the twice-daily 2000-mg dose of clarithromycin than with the twice-daily 500-mg dose, overall survival and median duration of survival were significantly lower in the 2000-mg group. Survival was not associated with severity of illness, level of bacteremia, time from culture positivity to study enrollment, or the CD4 cell count, and the authors did not explain the differences in survival between the two groups.
Adrenal insufficiency caused by M. avium complex infection has been reported in patients with HIV infection. In one study, 40% of patients with HIV infection and M. avium complex disease had adrenal involvement [2]. We have documented clinically overt adrenal insufficiency in 23% of patients with HIV infection and bacteremic M. avium complex infection at our institution. Signs and symptoms of adrenal insufficiency may be nonspecific; patients often present with varying severities of gastrointestinal symptoms. Chaisson and colleagues attributed the significantly higher incidence of gastrointestinal symptoms in the patients in the 2000-mg group to the higher dose of clarithromycin. Could these symptoms have represented occult adrenal insufficiency, which would also explain the poor survival of these patients?
1. Chaisson RE, Benson CA, Dube MP, Heifets LB, Korvick JA, Elkin S, et al. Clarithromycin therapy for bacteremic Mycobacterium avium complex disease. A randomized, double-blind, dose-ranging study in patients with AIDS. Ann Intern Med. 1994; 22:905-11.
2. Zakowski P, Fligiel S, Berlin OG, Johnson L. Disseminated Mycobacterium avium-intracellulare infection in homosexual men dying of acquired immunodeficiency. JAMA. 1982; 248:2980-2.
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