The Individual Microbiologic Effect of Three Antimycobacterial Agents, Clofazimine, Ethambutol, and Rifampin, on Mycobacterium avium Complex Bacteremia in Patients with AIDS

Abstract

The individual antibacterial activities of clofazimine, ethambutol, and rifampin in the treatment of Mycobacterium avium complex bacteremia in patients with AIDS were determined. Sixty human immunodeficiency virus 1-infected patients who had at least one blood culture positive for M. avium complex were randomized to receive either clofazimine (200 mg), ethambutol (15 mg/kg), or rifampin (600 mg) once daily for 4 weeks. Only ethambutol resulted in a statistically significant reduction in the level of mycobacteremia. The median change in individual baseline colony counts was −0.60 log₁₀ cfu/ml, after 4 weeks of ethambutol (P = .046). In contrast, median changes in individual baseline colony counts were −0.2 log₁₀ cfu/ml, and +0.2 log₁₀ cfu/ml, for clofazimine and rifampin, respectively (both, P > .4). Ethambutol had greater antibacterial activity, as determined by changes in the level of mycobacteremia, than either rifampin or clofazimine, supporting its continued use in combination with other agents in the treatment of M. avium infection.