James P. Steinberg, MD
To the Editors: The recent article by Chiu and colleagues (1) suggests that combination therapy with four drugs, including intravenous amikacin, decreases the mycobacterial load and symptoms associated with disseminated Mycobacterium avium complex infection in patients with the acquired immunodeficiency syndrome (AIDS). This may be so, but I think that this study raises an important but often avoided issue: Is it cost-effective to give expensive and potentially toxic intravenous therapy to large numbers of patients with AIDS who are in the terminal stage of their disease?
In a recent series (2), M. avium complex was cultured from 34% of patients
Steinberg JP. Cost of Treating Mycobacterium avium Complex Infection in AIDS. Ann Intern Med. ;113:995–996. doi: 10.7326/0003-4819-113-12-995_2
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Published: Ann Intern Med. 1990;113(12):995-996.
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