A 42-year-old HIV-positive woman (CD4 count 22 cells/μL, not on ART) reports 6 weeks of intermittent fever, drenching night sweats, weight loss, and vague right-sided abdominal discomfort. Examination shows hepatosplenomegaly. Alkaline phosphatase is markedly raised and two sets of blood cultures grow acid-fast bacilli identified as non-tuberculous mycobacteria. Which drug combination forms the core of her treatment?

• A Isoniazid, rifampicin, pyrazinamide, ethambutol
• B Azithromycin monotherapy
• C Amikacin plus moxifloxacin
• D Clarithromycin plus ethambutol ✓

Explanation

Disseminated Mycobacterium avium complex in advanced AIDS presents with fever, sweats, weight loss, hepatosplenomegaly and raised alkaline phosphatase, and is treated with a macrolide (clarithromycin or azithromycin) combined with ethambutol, with rifabutin often added. Antituberculous quadruple therapy is wrong because M. avium complex is inherently resistant to isoniazid and pyrazinamide, the fact that eliminates option A. Macrolide monotherapy selects for resistance and is never used as sole therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.