IDSA Recommendations for Preventing and Treating Disseminated Mycobacterium Avium Complex in HIV-AIDS

Preventing 1st Episode of Disseminated MAC Disease (Primary Prophylaxis):

Indications for Initiating Primary Prophylaxis:

 • CD4 count <50 cells/mm3 after ruling out disseminated MAC disease based on clinical assessment (which may include mycobacterial blood culture for some patients) (AI)

Preferred Therapy:

 • Azithromycin 1200 mg PO once weekly (AI), or

 • Clarithromycin 500 mg PO BID (AI), or

 • Azithromycin 600 mg PO twice weekly (BIII)

Alternative Therapy:

 • Rifabutin 300 mg PO daily (BI) (dosage adjusted may be necessary based on drug-drug interactions, please refer to Table 5 for dosing recommendation when used with ARV drugs).

Note: Active TB should be ruled out before starting rifabutin.

Indication for Discontinuing Primary Prophylaxis:

 • CD4 count >100 cells/mm3 for ≥3 months in response to ART (AI)

Indication for Restarting Primary Prophylaxis:

 • CD4 count <50 cells/mm3 (AIII)

Treating Disseminated MAC Disease

Preferred Therapy:

At least 2 drugs as initial therapy to prevent or delay emergence of resistance (AI)

 • Clarithromycin 500 mg PO twice daily (AI) + ethambutol 15 mg/kg PO daily (AI), or

 • Azithromycin 500–600 mg (AII) + ethambutol 15 mg/kg PO daily (AI) when drug interactions or intolerance precludes the use of clarithromycin



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