Prevention of opportunistic infections contributes to improved quality of life and survival in individuals with acquired immunodeficiency syndrome (AIDS). Agents which are more effective and convenient, less costly, and better tolerated are needed for multiple organism primary prophylaxis. Azithromycin, an azalide with high and prolonged intracellular levels, promises to provide protection against Mycobacterium avium complex (MAC) disease in those with advanced AIDS when given weekly. A large trial comparing rifabutin (300 mg daily), a currently approved primary prophylactic agent for MAC, with azithromycin (1200 mg weekly) has been completed and is under analysis. If weekly azithromycin provides equivalent or better protection from disseminated MAC, the cost, effectiveness and convenience of MAC prophylaxis may be improved.
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