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Drugs Used in MAC Infection

Drugs for treating Mycobacterium avium Complex (MAC) infection are classified based on their action against the bacterium. Below is a classification of these drugs, their mechanisms of action, adverse effects, and contraindications.

Classification of Drugs

1. Macrolides

  • Examples: Clarithromycin, Azithromycin
  • Mechanism of Action: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, preventing translocation of peptide chains.
  • Adverse Effects: Gastrointestinal upset, hepatotoxicity, prolonged QT interval, and skin rash.
  • Contraindications: Contraindicated in patients with hypersensitivity to macrolides. Caution in liver impairment and prolonged QT interval.

2. Rifamycins

  • Examples: Rifampicin, Rifabutin
  • Mechanism of Action: Inhibits DNA-dependent RNA polymerase, blocking RNA synthesis in mycobacteria.
  • Adverse Effects: Hepatotoxicity, orange discoloration of body fluids, gastrointestinal disturbances, and hypersensitivity reactions.
  • Contraindications: Contraindicated in severe hepatic impairment. Avoid with certain medications due to interactions (e.g., HIV protease inhibitors).

3. Ethambutol

  • Mechanism of Action: Inhibits arabinosyl transferase, crucial for cell wall synthesis in mycobacteria.
  • Adverse Effects: Optic neuritis, peripheral neuropathy, and gastrointestinal upset.
  • Contraindications: Contraindicated in patients with optic neuritis or those unable to report visual changes (e.g., young children).

4. Aminoglycosides

  • Examples: Amikacin, Streptomycin
  • Mechanism of Action: Binds to the 30S ribosomal subunit, causing mRNA misreading and inhibiting protein synthesis.
  • Adverse Effects: Nephrotoxicity, ototoxicity, vestibular toxicity, and neuromuscular blockade.
  • Contraindications: Contraindicated in renal impairment, hearing loss, or vestibular dysfunction. Caution in elderly patients.

5. Fluoroquinolones

  • Examples: Ciprofloxacin, Moxifloxacin
  • Mechanism of Action: Inhibits DNA gyrase and topoisomerase IV, essential for DNA replication and transcription.
  • Adverse Effects: Tendonitis and rupture, gastrointestinal upset, CNS effects (dizziness, confusion), and QT prolongation.
  • Contraindications: Avoid in children, pregnant women, and those with a history of tendon disorders or QT prolongation.
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