HIV in Children

TREATMENT OF MYCOBACTERIUM AVIUM COMPLEX (MAC)

Dr. Ira Shah
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Last Updated : 1st September 2012
  • Combination therapy with a minimum of 2 drugs is recommended.
  • Clarithromycin or Azithromycin plus Ethambutol are recommended.
  • Additional drugs such as Rifabutin, Ciprofloxacin, Amikacin or Streptomycin may be considered depending on severity of the disease.
  • For disseminated disease, 3 or 4 drugs are essential.
  • Most patients show improvement within 4-6 weeks. Treatment should then be continued with 2 drugs

Drugs

Dosage

Adverse Effects

Remarks
Clarithromycin 7.5-10 mg/kg/day PO BD
(max 1 gm/day)
Nausea, diarrhea, abdominal pain. Rare-Headache, leukopenia, altered taste, elevated transaminases Clarithromycin inhibits hepatic metabolism of other drugs cleared by the liver, thus potential drug interactions can occur
Azithromycin
10-12 mg/kg/day PO OD
(max 500 mg/day)
Nausea, diarrhea,
abdominal pain,
ototoxicity. Rare-
Headache, leukopenia, elevated transaminases
Useful when drug interactions with clarithromycin are a concern
Ethambutol
15-20 mg/kg/day PO OD
(max 1 gm/day)
Optic neuritis, colour blindness, Headache,
nausea, peripheral
neuropathy, rash,
hyperuricemia
Periodic monitoring for vision is required


TREATMENT OF MYCOBACTERIUM AVIUM COMPLEX (MAC)
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.