Comparison of Rifabutin-Based Versus Rifampin-Based Regimens for the Treatment of Mycobacterium avium Complex: A meta-Analysis Study Bahareh Hajikhani 1 , Mohammad Javad Nasiri 1 *, Brian C. Adkinson 2 , Taher Azimi 3 , Farima Khalili 1 , Mehdi Goudarzi 1 , Masoud Dadashi 4,5 , Mukunthan Murthi 2 and Mehdi Mirsaeidi 2 * 1 Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, 2 Department of Pulmonary and Critical Care University of Miami Miller School of Medicine Miami, Miami, FL, United States, 3 Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, 4 Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran, 5 Non-Communicable Diseases Research Center, Alborz University of Medical Sciences,Karaj, Iran Background: The incidence of Mycobacterium avium complex (MAC) increases as immunosuppressed conditions become more common. MAC’s standard treatment regimen includes a macrolide, ethambutol, and a rifamycin, among which rifampin and rifabutin are the most commonly used. Although current guidelines recommend initial therapy for MAC with rifampin, it has been theorized to be less efficacious than rifabutin. Methods: We reviewed the relevant scientific literature published up to February 18, 2020. Statistical analyses were performed with Comprehensive Meta-Analysis Software Version 2.0 (Biostat, Englewood, NJ). The pooled frequency with 95% confidence intervals (CI) was assessed using a random-effect model. We considered P <0.05 as statistically significant for publication bias. Results: After reviewing 3665 records, we identified 24 studies that satisfied the inclusion criteria. Among these studies, 8 had rifabutin in their regimens (rifabutin group) and 16 had rifampin in their regimens (rifampin group). The estimated pooled treatment success rate was found to be 54.7% (95% CI 41.0-67.0%) in rifabutin groups and 67.5% (95% CI 55.7- 77.4%) in rifampin groups. There was no evidence of publication bias among the included studies (Egger’s test p-value was 0.7). Conclusion: In this study, it was shown that in comparison to Rifabutin, rifampin has similar treatment success rates in treating MAC. In order to determine the exact preference of each of these drugs, double-blind clinical trial studies are recommended. Keywords: Mycobacterium avium complex, rifabutin, rifampin, meta-analysis, systematic rewiew Edited by: Domenico Criscuolo, Italian Society of Pharmaceutical Medicine, Italy Reviewed by: Paulo J. G. Bettencourt, Catholic University of Portugal, Portugal Patrícia Paiva Corsetti, Federal University of Alfenas, Brazil *Correspondence: Mohammad Javad Nasiri mj.nasiri@hotmail.com Mehdi Mirsaeidi msm249@med.miami.edu Specialty section: This article was submitted to Drugs Outcomes Research and Policies, a section of the journal Frontiers in Pharmacology Received: 13 April 2021 Accepted: 24 August 2021 Published: 07 September 2021 Citation: Hajikhani B, Nasiri MJ, Adkinson BC, Azimi T, Khalili F, Goudarzi M, Dadashi M, Murthi M and Mirsaeidi M (2021) Comparison of Rifabutin-Based Versus Rifampin-Based Regimens for the Treatment of Mycobacterium avium Complex: A meta- Analysis Study. Front. Pharmacol. 12:693369. doi: 10.3389/fphar.2021.693369 Frontiers in Pharmacology | www.frontiersin.org September 2021 | Volume 12 | Article 693369 1 SYSTEMATIC REVIEW published: 07 September 2021 doi: 10.3389/fphar.2021.693369