CLArithromycin Versus AZIthromycin in the Treatment of Mycobacterium Avium Complex (MAC) Lung Infections
Status:
Recruiting
Trial end date:
2023-02-01
Target enrollment:
Participant gender:
Summary
MAC lung infections are a growing public health problem. The ATS / IDSA 2007 guidelines for
the treatment of these non-tuberculous mycobacterial infections recommend the use of a
macrolide or azalide (clarithromycin or azithromycin), rifampicin or rifabutin and
ethambutol.
For MAC disseminated infections, several studies have compared combinations containing
clarithromycin or azithromycin and found no significant difference in efficacy. No randomized
controlled trials have been performed for pulmonary infections to compare clarithromycin and
azithromycin in terms of efficacy. Clarithromycin is often used as a first-line treatment in
France, but its tolerance is often poor, particularly in terms of risk of hepatitis, metallic
taste in the mouth, nausea or vomiting, and it interacts with many drugs via cytochrome p450
. In particular, it increases the toxicity of rifabutin, in particular in terms of uveitis.
Azithromycin has fewer side effects especially less digestive toxicity and drug interactions
than clarithromycin.
The hypothesis is therefore that the efficacy of azithromycin would be non-inferior in
comparison with that of clarithromycin.