- Combination therapy with a minimum of 2 drugs is recommended.
- Clarithromycin or Azithromycin plus Ethambutol are recommended.
- Additional drugs such as Rifabutin, Ciprofloxacin, Amikacin or Streptomycin may be considered depending on severity of the disease.
- For disseminated disease, 3 or 4 drugs are essential.
- Most patients show improvement within 4-6 weeks. Treatment should then be continued with 2 drugs
Drugs |
Dosage |
Adverse Effects |
Remarks |
Clarithromycin |
7.5-10 mg/kg/day PO BD
(max 1 gm/day) |
Nausea, diarrhea, abdominal pain. Rare-Headache, leukopenia, altered taste, elevated transaminases |
Clarithromycin inhibits hepatic metabolism of other drugs cleared by the liver, thus potential drug interactions can occur |
Azithromycin
|
10-12 mg/kg/day PO OD
(max 500 mg/day)
|
Nausea, diarrhea,
abdominal pain,
ototoxicity. Rare-
Headache, leukopenia, elevated transaminases
|
Useful when drug interactions with clarithromycin are a concern
|
Ethambutol
|
15-20 mg/kg/day PO OD
(max 1 gm/day)
|
Optic neuritis, colour blindness, Headache,
nausea, peripheral
neuropathy, rash,
hyperuricemia
|
Periodic monitoring for vision is required
|
Alternative drugs
| Rifabutin* |
10-20 mg/kg/day PO OD (max 300 mg/day) |
Leukopenia, GI upset, polyarthralgias, rash, elevated transaminases, skin and secretion discoloration, anterior uveitis |
>Rifabutin dose should be decreased by 50% when co-administered with Ritonavir, Indinavir, Nelfinavir and amprenavir. Dose of Rifabutin should be increased by 50% - 100% when co-administered with Efavirenz |
| Ciprofloxacin |
20-30 mg/kg/day IV/PO (max 1.5 mg/day) |
GI upset, Diarrhea, rash and headache. Cartilage damage in children |
Use with caution in children 18 years of age due to potential cartilage damage |
| Amikacin |
5-30 mg/kg/day IV / 1 M |
Ototoxicity and renal toxicity |
|
* Not available in India.
|
