Chart of opportunistic infections

October 2001     View PDF     En español

Mycobacterium avium complex (MAC)

MAC is a bacterial infection found in water, dust, soil and bird droppings.

Symptoms
Persistent fever, night sweats, fatigue, weight loss, anemia, abdominal pain, dizziness, diarrhea and weakness.

Diagnosis
Culture from a sterile site such as blood, bone marrow or cerebral spinal fluid.

Preventive Therapy (prophylaxis)
People whose CD4+ cell counts stay consistently below 50 should start preventive therapy.

Preferred: Clarithromycin (500mg twice a day); or azithromycin
(1,200mg once a week).

Alternative: Rifabutin (300mg once a day).

Stopping Preventive Therapy
People with sustained CD4+ cells above 100 for 3–6 months and sustained viral load suppression may consider stopping preventive therapy.

Treatment
Preferred: Azithromycin (500–600mg once a day); or clarithromycin (500mg twice a day) + ethambutol (15mg/kg/day) + rifabutin (300mg once a day).

Alternative: Azithromycin or clarithromycin + ethambutol + rifabutin +/- ciprofloxacin (500–750mg twice a day) +/- IV amikacin (10–15mg/kg/day).

IV amikacin can be added for severe disease.

Higher doses of clarithromycin (1,000mg twice a day) may be linked with increased risk of death. Clofazimine may be associated with increased side effects and risk of death and it should not be used.

Maintenance Therapy
Everyone who has had MAC should be on maintenance therapy with either clarithromycin (500mg twice a day) or azithromycin (500mg once a day) if it has been proven there is no resistance to either drug + ethambutol (15mg/kg once a day) +/- rifabutin (300mg once a day).

Stopping Maintenance Therapy
People with sustained CD4+ cells above 100 for 6–12 months as a result of potent anti-HIV therapy may consider stopping maintenance therapy.

For more information, read Project Inform’s publication, Mycobacterium avium Complex.