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Clarithromycin Therapy for Mycobacterium avium Complex Bacteremia
- Nina Singh; and
- Victor L. Yu
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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?
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
