The rare ethambutol-induced optic neuropathy

Song, Wei; Si, Shancheng

doi:10.1097/md.0000000000005889

Cited by 23 publications

(12 citation statements)

References 16 publications

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“…EMB-induced optic neuropathy is a well-known complication of EMB administration, the severity of which is dose dependent (16). A systematic review showed that the incidence of all visual impairments and permanent visual impairments associated with EMB treatment was 19.2 and 2.3 persons per 1,000 patients, respectively, when the patients were treated with the standard dose for 2 to 9 months (17).…”

Section: Discussionmentioning

confidence: 99%

Early Discontinuation of Ethambutol in Pulmonary Tuberculosis Treatment Based on Results of the GenoType MTBDRplus Assay: a Prospective, Multicenter, Noninferiority Randomized Trial in South Korea

Kim

et al. 2019

Antimicrob Agents Chemother

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No studies have investigated whether the discontinuation of ethambutol (EMB) based on susceptibility to isoniazid and rifampin, as determined by the GenoType MTBDRplus assay, would be appropriate. We aimed to determine the feasibility of discontinuing EMB before the end of the intensive phase of treatment based on the results of the MTBDRplus assay in patients with pulmonary tuberculosis (PTB). This prospective, multicenter noninferiority randomized trial was conducted at 12 referral centers in South Korea in drug-susceptible PTB patients who initiated the standard four-drug regimen for PTB. Based on the results of the assay, EMB was discontinued in the MTBDRplus group after confirmation that the M. tuberculosis isolate was susceptible to isoniazid and rifampin. The time point for EMB discontinuation in the guideline group was determined using the results of the phenotypic drug susceptibility test based on the South Korean national tuberculosis guidelines. The primary outcome was treatment success. Secondary outcomes included the 1-year rates of recurrence and adverse events. Of 600 randomized patients, the treatment outcome analysis was performed for 493 patients (MTBDRplus group, 244 patients; guideline group, 249 patients). Treatment success rates were 93.9% (229/244) in the MTBDRplus group and 93.6% (233/249) in the guideline group and did not differ between groups (relative risk, 1.00; 95% confidence interval, 0.95 to 1.06). The 1-year recurrence rates in the two groups (0.9% and 0.5%, respectively) and adverse drug reactions did not differ between the groups. In conclusion, the early discontinuation of EMB based on the results of the MTBDRplus assay did not affect the treatment outcomes in patients with PTB. (This clinical trial has been registered with the Clinical Research Information Service of the Republic of Korea [https://cris.nih.go.kr/cris/] under registration no. KCT0000610.)

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Section: Discussionmentioning

confidence: 99%

Early Discontinuation of Ethambutol in Pulmonary Tuberculosis Treatment Based on Results of the GenoType MTBDRplus Assay: a Prospective, Multicenter, Noninferiority Randomized Trial in South Korea

Kim

et al. 2019

Antimicrob Agents Chemother

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“…6 The time of onset of ehambutol induced optic neuritis is not predictable, but it usually starts between 4 to 12 months after initiation of therapy, but can also occur as early as within days of therapy. 7,9,10 The other factors which can contribute to this adverse effect are the age of the patient, duration of treatment, the renal status, alcohol and smoking habits of the patient, other concurrent illness like hypertension, and diabetes in the patient. 11 Patients usually present with progressive painless loss of vision, identified initially as blurring of vision during reading suggestive of central field defects.…”

Section: Discussionmentioning

confidence: 99%

Ethambutol induced optic neuritis: a case series

Sruthi¹,

Anuradha²

2019

Int J Basic Clin Pharmacol

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Ethambutol is one of the first line chemotherapeutic agents used in the treatment of tuberculosis used both in the intensive and continuation phase according to the new Revised National Tuberculosis Control Program guidelines. Patient acceptability is rather good with this drug as it produces comparatively lesser adverse effects. The most important and serious side effect reported is optic neuritis, resulting in loss of visual acuity, color vision and field defects. The incidence of optic neuritis is generally directly proportional to the dose and duration of ethambutol therapy. Here we report four cases of ethambutol induced optic neuritis in patients on fixed dose combinations (FDC) of ethambutol, isoniazid, pyrazinamide and rifampicin who presented in Ophthalmology OPD in a span of 2 months, between June and July 2019. Contradictory to the rare occurrence of ethambutol induced optic neuritis this comparatively higher incidence of optic neuritis is alarming. We observed that the presentation of ethambutol induced optic neuritis can vary and dose of ethambutol along with other factors can also contribute to it. So proper pre-treatment evaluation, dosage adjustment, periodic monitoring and early detection have a significant role in prevention and treatment of ethambutol induced optic neuritis.

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“…Further, prolonged usage of ethambutol is also associated with deficiencies in vitamins E and B12, which additionally exacerbate the symptoms of optic neuropathy. Most common symptoms of EON include the painless loss of central vision and the presence of cecocentral scotomas in the field of vision [ 126 ]. The majority of patients present with bilateral, symmetric loss of central visual acuity as well as dyschromatopsia [ 125 ].…”

Section: Optic Neuropathy Induced By Toxic Substancesmentioning

confidence: 99%

Toxic and Nutritional Optic Neuropathies—An Updated Mini-Review

Baj

Forma

Kobak

et al. 2022

IJERPH

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Optic neuropathies constitute a group of conditions with various etiologies and might be caused by different factors; we can distinguish the genetic and acquired causes of optic neuropathies. Even though the symptoms are not highly specific, this condition is primarily characterized by unilateral or bilateral vision loss with worsening color detection. The loss may be acute or gradual depending on the causation. In this article, we included a specification of toxic optic neuropathy (TON) mainly triggered by alcohol abuse and also the usage of other substances, including drugs or methanol, as well as intoxication by metals, organic solvents, or carbon dioxide. Nutritional deficiencies, vitamin absorption disorder, and anemia, which usually appear during excessive alcohol intake, and their effect on the etiology of the optic neuropathy have been likewise discussed.

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The rare ethambutol-induced optic neuropathy

Cited by 23 publications

References 16 publications

Early Discontinuation of Ethambutol in Pulmonary Tuberculosis Treatment Based on Results of the GenoType MTBDRplus Assay: a Prospective, Multicenter, Noninferiority Randomized Trial in South Korea

Early Discontinuation of Ethambutol in Pulmonary Tuberculosis Treatment Based on Results of the GenoType MTBDRplus Assay: a Prospective, Multicenter, Noninferiority Randomized Trial in South Korea

Ethambutol induced optic neuritis: a case series

Toxic and Nutritional Optic Neuropathies—An Updated Mini-Review

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