Clarithromycin-Rifampin-Based Treatment for Nontuberculous Mycobacteria Infections in Immunocompromised Patients who Require Concomitant CYP-Metabolized Medications

Isabel H Gonzalez-Bocco; Muneerah M Aleissa; Eric Zhou; Jennifer Manne-Goehler; Sophia Koo; Matthew P Cheng; Francisco M Marty

doi:10.1093/ofid/ofab582

Clarithromycin-Rifampin-Based Treatment for Nontuberculous Mycobacteria Infections in Immunocompromised Patients who Require Concomitant CYP-Metabolized Medications

Open Forum Infect Dis. 2021 Dec 18;9(1):ofab582. doi: 10.1093/ofid/ofab582. eCollection 2022 Jan.

Authors

Isabel H Gonzalez-Bocco^{1

2

3}, Muneerah M Aleissa^{1

2

4}, Eric Zhou^{1

2}, Jennifer Manne-Goehler^{2

3

5}, Sophia Koo^{1

2

3}, Matthew P Cheng^{6

7

8}, Francisco M Marty^{1

2

3}

Affiliations

¹ Division of Infectious Disease, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
² Division of Infectious Disease, Brigham and Women's Hospital, Boston, Massachusetts, USA.
³ Harvard Medical School, Boston, Massachusetts, USA.
⁴ Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵ Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁶ Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
⁷ Division of Medical Microbiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
⁸ McGill Interdisciplinary Initiative in Infection and Immunity, Montreal, Quebec, Canada.

Abstract

Clarithromycin (CYP inhibitor) can be used instead of azithromycin for nontuberculous mycobacteria therapy in patients requiring CYP substrates to mitigate rifampin's CYP induction. We found no differences in adverse events (10/13 vs 14/17; P = .73), drug intolerability (1/5 vs 4/11; P = 1), or 90-day mortality (0/13 vs 1/17; P = 1) in patients receiving clarithromycin vs azithromycin.

Keywords: Mycobacterium avium complex; clarithromycin; immunocompromised host; nontuberculous mycobacteria.