The effect of fusidic acid on Tanzanian patients with AIDS [letter]

Researchers assigned 60 seriously ill AIDS patients with chronic diarrhea approximately 30% involuntary weight loss and occasional fevers over a 1 month period to treatment with fusidic acid or a placebo for 4 weeks. 11 patients were lost to follow-up. The mean age for all patients stood at 31.9 years. 33 patients were men. Those individuals in the fusidic acid group received a 1 g dose in 2 tablets twice a day. 7 patients in the fusidic acid group and 15 in the placebo group died during the 4 week trial period (p<.03). The difference in mortality became more significant after 2 weeks. The researchers could not explain this finding by differences in alternative treatment body temperature presence of opportunistic infections anemia the number of stools or laboratory findings. Further the mean level of beta 2- microglobulin fell from 5.6-3.8 mg/l in the fusidic acid group while it rose from 3.4-3.8 mg/l in the placebo group. In addition the researchers could not explain the difference in morality by weight at entry because the median weight for those lost at follow up for the fusidic acid patients was 43.5 kg and 38 kg for the placebo patients. Those who lived had a higher median weight (42.2 kg) than those who died (36.6 kg) [p=.008]. When researchers looked at initial weight by doing a multiple logistic regression analysis however the difference was reduced (p=.13). Nevertheless the results do suggest that fusidic acid may indeed benefit AIDS patients in Africa due to either its antimicrobial effect or an immunomodulating effect with reduced interleukin-1 function. Side effects were limited and comparable for both groups.