In addition to starting ART, to fight MAC you'll probably get a combination of antibiotics so your body doesn't become resistant to any one drug. You will likely get either clarithromycin ( Biaxin) or azithromycin ( Zithromax) plus ethambutol.
What are the treatment regimens for disseminated MAC?
Therapy of Disseminated MAC 1 Treatment regimens outside a clinical trial should include at least two agents. 2 Every regimen should contain either azithromycin or clarithromycin; many experts prefer ethambutol as... 3 Therapy should continue for the lifetime of the patient if clinical and microbiologic improvement is...
When is chemoprophylaxis indicated in the treatment of disseminated MAC?
People with HIV who are not receiving ART or who remain viremic on ART but have no current options for a fully suppressive ART regimen should receive chemoprophylaxis against disseminated MAC disease if they have CD4 counts <50 cells/mm 3 (AI).
What are disseminated MAC infections?
Disseminated MAC infections spread throughout your body through your bloodstream and most commonly affect people with advanced AIDS and other types of immunocompromised conditions. MAC-associated lymphadenitis mainly affects healthy children.
What are the treatment guidelines for disseminated cytomegalovirus (Mac)?
If disseminated MAC develops, a treatment regimen containing clarithromycin or azithromycin and at least one other agent is recommended. Diagnosis, therapy, and prophylaxis for HIV-infected children follow similar guidelines.
What is the best treatment for MAC?
In general, MAC infection is treated with 2 or 3 antimicrobials for at least 12 months. Commonly used first-line drugs include macrolides (clarithromycin or azithromycin), ethambutol, and rifamycins (rifampin, rifabutin). Aminoglycosides, such as streptomycin and amikacin, are also used as additional agents.
What is the treatment for MAC lung disease?
MAC lung disease diagnosis includes a clinical exam, a chest x-ray or CT scan and a lab culture of sputum from your lungs. MAC lung disease treatment usually involves a combination of antibiotics taken over an extended period of time.
What is disseminated MAC infection?
Disseminated Mycobacterium avium-intracellulare complex (MAC) infection is a relatively common complication seen in advanced HIV, especially when the CD4 lymphocyte count falls below 50 cells/mm in the absence of appropriate prophylaxis.
What is the treatment for Mycobacterium?
Doctors typically recommend a combination of three to four antibiotics, such as clarithromycin, azithromycin, rifampin, rifabutin, ethambutol, streptomycin, and amikacin. They use several antibiotics to prevent the mycobacteria from becoming resistant to any one medication.
When do you treat MAC?
Providers consider MAC lung disease to be cured if sputum cultures show no evidence of infection for 12 months. But the infection can come back, either from a new exposure or lingering bacteria in the lungs, especially since the condition that made you susceptible to MAC is still present.
Should MAC be treated?
In general, antimycobacterial treatment of MAC should only be considered in patients who meet the clinical, radiographic, and microbiologic criteria for the diagnosis of nontuberculous mycobacterial (NTM) infection (table 1) [3]. (See "Diagnosis of nontuberculous mycobacterial infections of the lungs".)
What is the difference between MAC and TB?
M. tuberculosis is spread through the air. MAC is a common bacterium found primarily in water and soil. You can contract it when you drink or wash with contaminated water or handle soil or eat food with MAC-containing particles on it.
What is the usual method of transmission for Mycobacterium avium intracellulare?
MAC is transmitted via inhalation into the respiratory tract and ingestion into the GI tract. It then translocates across mucosal epithelium, infects the resting macrophages in the lamina propria and spreads in the submucosal tissue. MAC is then carried to the local lymph nodes by lymphatics.
Is Mycobacterium avium complex TB?
Mycobacterium avium complex (MAC) is a group of bacteria related to tuberculosis. These germs are very common in food, water, and soil. Almost everyone has them in their bodies.
What are MAC drugs?
The drugs used most often for treatment of Mycobacterium avium complex (MAC) infection include a macrolide (eg, clarithromycin, azithromycin), ethambutol, and a rifamycin (eg, rifabutin, rifampin). Clarithromycin or azithromycin in combination with ethambutol and rifabutin are the first-choice drugs.
Does doxycycline treat Mycobacterium?
The antimicrobial agents amikacin and doxycycline, which are not conventionally considered for use in treatment of mycobacterial infections, inhibit growth of Mycobacterium fortuitum and Mycobacterium chelonei in vitro. Ten patients were treated with these drugs alone or in combination with some surgical procedure.
Why do Mycobacterium infection have to be treated for 6+ months?
Both latent TB infection and active TB disease are treated with antibiotics. Treatment lasts at least six months because antibiotics work only when the bacteria are actively dividing, and the bacteria that cause TB grow very slowly.
What is the best treatment for MAC?
1,6,11,12,14,48-56 Clarithromycin is the preferred first agent (AI); it has been studied more extensively than azithromycin in people with AIDS and appears to be associated with more rapid clearance of MAC from the blood. 6,48,50,54,55,57 However, azithromycin can be substituted for clarithromycin when drug interactions or intolerance preclude the use of clarithromycin (AII). Testing MAC isolates for susceptibility to clarithromycin or azithromycin is recommended for all people with HIV. 58,59
What is a confirmed diagnosis of disseminated MAC disease?
A confirmed diagnosis of disseminated MAC disease is based on compatible clinical signs and symptoms coupled with the isolation of MAC from cultures of blood, lymph node, bone marrow, or other normally sterile tissue or body fluids. 16,24,25,34,35 Species identification should be performed using molecular techniques, polymerase chain reaction-based assays, whole genome sequencing, high-performance liquid chromatography, or biochemical tests.
How long does it take for a MAC to fail?
MAC treatment failure is defined by the absence of a clinical response and the persistence of mycobacteremia after 4 to 8 weeks of treatment. Repeat testing of MAC isolates for susceptibility to clarithromycin or azithromycin is recommended for people with HIV whose disease relapses after an initial response to treatment. Most people with HIV who experience failure of clarithromycin or azithromycin primary prophylaxis in clinical trials had isolates susceptible to these drugs when MAC disease was detected. 6,11,12,48,75,76
How long does it take to get a repeat blood culture for MAC?
Monitoring of Response to Therapy and Adverse Events (including IRIS) A repeat blood culture for MAC should be obtained 4 weeks to 8 weeks after initiating antimycobacterial therapy only in people with HIV who do not have a clinical response to their initial treatment regimens.
How does MAC spread?
The mode of MAC transmission is thought to be through inhalation, ingestion, or inoculation of MAC bacteria via the respiratory or gastrointestinal (GI) tract. 1,14 Household or close contacts of those with MAC disease do not appear to be at increased risk of disease, and person-to-person transmission is unlikely.
What are ancillary studies?
Other ancillary studies provide supportive diagnostic information, including acid-fast bacilli smear and culture of stool or tissue biopsy material, radiographic imaging, or other studies aimed at isolating organisms from focal infection sites.
Is clarithromycin a prophylactic agent?
As previously stated, primary prophylaxis for MAC is not recommended, but for those for whom prophylaxis is being considered, azithromycin 45 and clarithromycin 5,46 are the preferred prophylactic agents (AI). 1,47 The combination of clarithromycin and rifabutin is no more effective than clarithromycin alone for chemoprophylaxis, is associated with a higher rate of adverse effects than either drug alone, and should not be used (AI). 5 The combination of azithromycin and rifabutin is more effective than azithromycin alone in preventing MAC disease. 45 However, based on the additional cost, increased occurrence of adverse effects, potential for drug interactions, and no greater survival benefit than with azithromycin alone, the combination regimen of azithromycin and rifabutin is not recommended (AI). Azithromycin and clarithromycin also each confer protection against respiratory bacterial infections. In people with HIV who cannot tolerate azithromycin or clarithromycin, rifabutin is an alternative prophylactic agent for MAC disease (BI), although drug interactions may complicate use of this agent. Before prophylaxis is initiated, disseminated MAC disease should be ruled out by clinical assessment and if appropriate based on that assessment, by obtaining a blood culture for MAC. TB also should be excluded before rifabutin is used for MAC prophylaxis because treatment with rifabutin monotherapy could result in acquired resistance to M. tuberculosis in people with HIV who have active TB.
What is MAC in HIV?
Diagnosis, therapy, and prophylaxis for HIV-infected children follow similar guidelines. INTRODUCTION. Mycobacterium avium complex (MAC) causes disseminated disease in up to 40% of patients with human immunodeficiency virus (HIV) in the United States, producing fever, sweats, weight loss, and anemia (1-3).
How old do you have to be to get MAC?
HIV-infected children less than 12 years of age also develop disseminated MAC. Some age adjustment is necessary when clinicians interpret CD4+ T-lymphocyte counts in children less than 2 years of age. Diagnosis, therapy, and prophylaxis should follow recommendations similar to those for adolescents and adults.
Can a blood culture be performed for asymptomatic patients?
Blood cultures should be performed in patients with symptoms, signs, or laboratory abnormalities compatible with mycobacterium infection. Blood cultures are not routinely recommended for asymptomatic persons, even for those who have CD4+ T-lymphocyte counts less than 100 cells/uL. Therapy of Disseminated MAC.
Is azithromycin safe for MAC?
Although other drugs, such as azithromycin and clarithromycin, have laboratory and clinical activity against MAC, none has been shown in a prospective, controlled trial to be effective and safe for prophylaxis. Thus, in the absence of data, no other regimen can be recommended at this time.
Is isoniazid effective for MAC?
Isoniazid and pyrazinamide are not effective for the therapy of MAC. Therapy should continue for the lifetime of the patient if clinical and microbiologic improvement is observed. Monitoring Patients Receiving Therapy for Disseminated MAC.
Is clarithromycin a second drug?
Every regimen should contain either azithromycin or clarithromycin; many experts prefer ethambutol as a second drug. Many clinicians have added one or more of the following as second, third, or fourth agents: clofazimine, rifabutin, rifampin, ciprofloxacin, and in some situations amikacin.
What is the treatment for MAC?
If disseminated MAC develops, a treatment regimen containing clarithromycin or azithromycin and at least one other agent is recommended. Diagnosis, therapy, and prophylaxis for HIV-infected children follow similar guidelines.
How many CD4+ T lymphocytes should be used for MAC?
Patients with HIV infection and less than 100 CD4+ T-lymphocytes/uL should be administered prophylaxis against MAC. Prophylaxis should be continued for the patient's lifetime unless multiple drug therapy for MAC becomes necessary because of the development of MAC disease.
What is MAC in HIV?
Mycobacterium avium complex (MAC) causes disseminated disease in up to 40% of patients with human immunodeficiency virus (HIV) in the United States, producing fever, sweats, weight loss, and anemia (1-3). Disseminated MAC characteristically affects patients with advanced HIV disease and peripheral CD4+ T-lymphocyte counts less than 100 cells/uL.
How old do you have to be to get MAC?
HIV-infected children less than 12 years of age also develop disseminated MAC. Some age adjustment is necessary when clinicians interpret CD4+ T-lymphocyte counts in children less than 2 years of age. Diagnosis, therapy, and prophylaxis should follow recommendations similar to those for adolescents and adults.
What should be assessed before prophylaxis?
Before prophylaxis is administered, patients should be assessed to ensure that they do not have active disease due to MAC, M. tuberculosis, or any other mycobacterial species. This assessment may include a chest radiograph and tuberculin skin test. Prophylactic Regimens
Is azithromycin safe for MAC?
Although other drugs, such as azithromycin and clarithromycin, have laboratory and clinical activity against MAC, none has been shown in a prospective, controlled trial to be effective and safe for prophylaxis. Thus, in the absence of data, no other regimen can be recommended at this time.
Can a blood culture be performed for asymptomatic patients?
Blood cultures should be performed in patients with symptoms, signs, or laboratory abnormalities compatible with mycobacterium infection. Blood cultures are not routinely recommended for asympto matic persons, even for those who have CD4+ T-lymphocyte counts less than 100 cells/uL.
Overview
A group of bacteria called Mycobacterium avium complex (MAC) causes MAC lung disease. Most people who breathe in or swallow these germs don’t get sick. But some pre-existing conditions can make some people more susceptible to developing a slow-growing infection once MAC enters their airway.
Symptoms and Causes
MAC bacteria naturally reside in soil and water. Stirring up soil or dust can make the bacteria airborne, and you may breathe them in. People who garden or work with soil have slightly more MAC than those who don’t. MAC is also in water, including the water in your home.
Diagnosis and Tests
Your healthcare provider will perform a physical exam and ask about symptoms.
Management and Treatment
Because MAC lung disease is difficult to get rid of, you may see an infectious disease or a pulmonary specialist. Both specialties have expertise in diagnosing and treating infections.
Prevention
Avoid hot tubs and saunas that recirculate hot, steamy water if your provider feels they may have been the source of your MAC bacteria.
Frequently Asked Questions
While you can’t catch a MAC infection from someone else, the condition sometimes affects more than one family member. Experts believe certain people have a genetic change (mutation) that makes them more susceptible to MAC infections.