Low Serum Levels of Oral Antimycobacterial Agents in Patients with Disseminated Mycobacterium avium Complex Disease

• Published in: The Journal of infectious diseases 1993-12, Vol.168 (6), p.1559-1562
• Main Authors: Gordon, Steven M., Horsburgh, C. Robert, Peloquin, Charles A., Havlik, Joseph A., Metchock, Beverly, Heifets, Leonid, McGowan, John E., Thompson, Sumner E.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Adult; AIDS-Related Opportunistic Infections - blood; AIDS-Related Opportunistic Infections - drug therapy; AIDS/HIV; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - blood; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Ciprofloxacin - administration & dosage; Ciprofloxacin - blood; Ciprofloxacin - therapeutic use; Clofazimine - administration & dosage; Clofazimine - blood; Clofazimine - therapeutic use; Drug Monitoring; Ethambutol - administration & dosage; Ethambutol - blood; Ethambutol - therapeutic use; Female; human immunodeficiency virus; Humans; Male; Medical sciences; Microbial Sensitivity Tests; Mycobacterium avium; Mycobacterium avium Complex - drug effects; Mycobacterium avium-intracellulare Infection - blood; Mycobacterium avium-intracellulare Infection - complications; Mycobacterium avium-intracellulare Infection - drug therapy; Pharmacology. Drug treatments; Prospective Studies; Rifampin - administration & dosage; Rifampin - blood; Rifampin - therapeutic use
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/168.6.1559

Twenty-sevenhuman immunodeficiencyvirus-infected patients with disseminated Mycobacterium avium complex disease who were treated with oral antimycobacterial agents (clofazimine, ciprofioxacin, ethambutol, and rifampin) were studied to evaluate the usefulness of monitoring serum drug concentrations and testing in vitro susceptibility of M. avium complex (MAC) isolates. Twenty patients tolerated treatment with three or four antimycobacterial agents for at least 8 weeks; mycobacteremia was eradicated in 7 (35%).The in vitro susceptibilities of MAC isolates to antimycobacterial agents were similar for these 7 and for the 13 who did not respond to antimycobacterial treatment. Serum drug levels were below the expected range in 6 of the 7 whose mycobacteremia was cleared and in 9 ofthe 13 nonresponders (P = .41). These low serum concentrations of antimycobacterial drugs may be due to impaired drug absorption in patients with AIDS and disseminated MAC disease.