The macrolide antibiotics (see Chapter 47) clar-ithromycin and azithromycin have demonstrated in vitro activity against mycobacteria, although they have limited activity against M. tuberculosis. Clarithromycin is four times as active as azithromycin against M. avium-intracellulare in vitro. Azithromycin's lower potency may be compensated for by its greater intracellular penetration and its two-fold higher tissue levels than plasma levels. Clarithromycin with azithromycin, in combination with other drugs, has gained an important role in the prevention and treatment of MAC in HIV-infected patients.

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