Ethambutol optic neuropathy

Chamberlain, Paul; Sadaka, Ama; Berry, Shauna; Lee, Andrew G.

doi:10.1097/icu.0000000000000416

Cited by 67 publications

(52 citation statements)

References 55 publications

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“…Although maintenance of ethambutol appears to be very important in the treatment of MAC-PD, the possibility of optic neuropathy should be considered with prolonged use of ethambutol. Among patients taking ethambutol for pulmonary TB, ethambutol-induced optic neuropathy develops in 1–2% in a dose-dependent manner [35]. In addition, about 0.2–0.3% of patients may experience irreversible visual function loss.…”

Section: Discussionmentioning

confidence: 99%

Role of ethambutol and rifampicin in the treatment of Mycobacterium avium complex pulmonary disease

et al. 2019

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BackgroundA three-drug regimen (macrolide, ethambutol, and rifampicin) is recommended for the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Although macrolide has proven efficacy, the role of ethambutol and rifampicin in patients without acquired immune deficiency syndrome is not proven with clinical studies. We aimed to clarify the roles of ethambutol and rifampicin in the treatment of MAC-PD.MethodsPatients treated for MAC-PD between March 1st, 2009 and October 31st, 2018 were reviewed retrospectively. Rates of culture conversion, microbiological cure, treatment failure, and recurrence were compared according to the maintenance (≥6 months) of ethambutol or rifampicin with macrolide.ResultsAmong the 237 patients, 122 (51.5%) maintained ethambutol and rifampicin with macrolide, 58 (24.5%) maintained ethambutol and macrolide, 32 (13.5%) maintained rifampicin and macrolide, and 25 (10.6%) maintained macrolide only. Culture conversion was reached for 190/237 (80.2%) patients and microbiological cure was achieved for 129/177 (72.9%) who completed the treatment. Treatment failure despite ≥12 months of treatment was observed in 66/204 (32.4%), and recurrence was identified in 16/129 (12.4%) who achieved microbiological cure. Compared with maintenance of macrolide only, maintenance of ethambutol, rifampicin or both with macrolide were associated with higher odds of culture conversion [odds ratio (OR), 95% confidence interval (CI): 18.06, 3.67–88.92; 15.82, 2.38–105.33; and 17.12, 3.93–74.60, respectively]. Higher odds of microbiological cure were associated with maintenance of both ethambutol and rifampicin with macrolide (OR, 95% CI: 5.74, 1.54–21.42) and macrolide and ethambutol (OR, 95% CI: 5.12, 1.72–15.24) but not macrolide and rifampicin. Maintenance of both ethambutol and rifampicin with macrolide was associated with lower odds of treatment failure (OR, 95% CI: 0.09, 0.01–0.53) compared with macrolide only, while maintenance of one of these with macrolide was not. Maintenance of both ethambutol and rifampicin or one of these with macrolide did not decrease the probability of recurrence when compared with macrolide only.ConclusionsMaintenance (≥6 months) of ethambutol and rifampicin with macrolide was associated with the most favorable treatment outcomes among patients with MAC-PD. Given the association between ongoing ethambutol use and microbiological cure, clinicians should maintain ethambutol unless definite adverse events develop.

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Section: Discussionmentioning

confidence: 99%

Role of ethambutol and rifampicin in the treatment of Mycobacterium avium complex pulmonary disease

et al. 2019

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“…The recovery rate was slightly higher in this study compared to previous studies (30-64%). 3,5,7,8 This could be attributed to the different de nitions of visual improvement used. In a previous study, although the visual acuity improved in some patients, other visual functions, including color vision, visual eld, and electrophysiology, showed dysfunctions.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Although ethambutol (EMB) hydrochloride is the rst-line agent for treating tuberculosis, it has been associated with side effects. 3 Among these side effects, EMB toxic optic neuropathy (ETON) commonly occurs during the course of the medication. 4 However, only a few studies have investigated the natural course of ETON or response to discontinuation of EMB hydrochloride.…”

Section: Introductionmentioning

confidence: 99%

Natural Course and Prognostic Factors of Ethambutol Toxic Optic Neuropathy

Kim

Lim

Kim

2020

Preprint

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Background: To investigate the natural course and prognostic factors of ethambutol toxic optic neuropathy (ETON).Methods: Medical charts of 87 patients diagnosed with ETON were reviewed retrospectively, and the visual acuity and history of ethambutol medication were analyzed. Based on the final visual acuity, patients were divided into two groups: recovery and no-recovery groups. We investigated the prognostic factors, including the sex, age, duration of medication, initial visual acuity, and systemic diseases (diabetes mellitus, hypertension, renal disorders, etc.). Results: In this study, 37 men and 50 women, with ages ranging from 22 to 91 years, were included. Although a poor initial visual acuity was noted in the old patients, a short duration of medication had a weak negative correlation with the initial visual acuity. Follow-up of over 1 year could be performed for 28 out of 87 patients, including nine men and 19 women, with a mean age of 70.0 ± 8.2 years. Ten eyes of seven (25%) patients, including three men and four women, did not recover vision after discontinuation of ethambutol. Patients were significantly older in the no-recovery group than in the recovery group (73.9 ± 8.3 and 68.7 ± 8.1 years, respectively). The poor initial visual acuity and presence of systemic diseases affected the prognosis of ETON. Conclusion: Three-fourth of patients with ETON had visual recovery after discontinuation of ethambutol. High-risk patients with poor prognostic factors, including old age, presence of systemic diseases, and poor initial visual acuity, should be screened in early stages of ETON.

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“…Unilateral visual loss in the context of concurrent usage of ethambutol raises the possibility of a drug-related side effect—ethambutol-related optic neuropathy (EON) 1. Ethambutol is a bacteriostatic antimicrobial agent.…”

Section: Differential Diagnosismentioning

confidence: 99%

Neuromyelitis optica spectrum disorder and active tuberculosis

et al. 2020

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Tuberculosis is on the rise again. It brings with it potential for neurological involvement both as a direct infection and as a parainfectious process. Accordingly we report the development of neurological problems affecting a 48-year-old patient’s vision and sensation while being treated for active tuberculosis. At its nadir her vision deteriorated to nil perception of light and she had a sensory level to T10. Neuromyelitis optica spectrum disorder was diagnosed. We discuss our management strategy with neuromodulation in the context of active tuberculosis infection.

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Ethambutol optic neuropathy

Cited by 67 publications

References 55 publications

Role of ethambutol and rifampicin in the treatment of Mycobacterium avium complex pulmonary disease

Role of ethambutol and rifampicin in the treatment of Mycobacterium avium complex pulmonary disease

Natural Course and Prognostic Factors of Ethambutol Toxic Optic Neuropathy

Neuromyelitis optica spectrum disorder and active tuberculosis

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