Ocular toxicity with ethambutol therapy: Timely recaution

Koul, Parvaiz A

doi:10.4103/0970-2113.148395

Cited by 37 publications

(36 citation statements)

References 25 publications

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“…Although administration of not less than 1000 mg d −1 is permitted in Japan, depending on patient weight, for up to 2 months starting from initial administration as treatment for pulmonary tuberculosis, it is not recommended to continue beyond that point regardless of patient weight . Incidence rate is low at standard doses, but optic nerve phase is the most likely side effect of ethambutol . Other studies have reported loss of vision in response to long‐term high doses of EB.…”

Section: Discussionmentioning

confidence: 99%

A survey of clarithromycin monotherapy and long‐term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims

Iwao

Kato

Ito

et al. 2019

Pharmacoepidemiology and Drug

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Background: The number of patients with nontuberculous mycobacteriosis (NTM) has increased exponentially in recent years. In Japan, approximately 88.8% of patients with NTM suffer from Mycobacterium avium-intracellulare complex (MAC) lung disease. Incidence of MAC lung disease is increasing in particularly among the middle-aged and elderly women owing to a rapid increase in nontuberculous mycobacterial infections.General treatment for MAC lung disease is chemotherapy. The type of chemotherapy recommended by specialists to prevent the development of a drug-resistant strain of the bacteria consists of a combination of clarithromycin (CAM), rifampicin, and ethambutol (EB). CAM monotherapy is contraindicated by specialists owing to its high potential to induce drug-resistant bacterial strains in patients with MAC lung disease.In addition, administering EB at doses not less than 1000 mg d −1 is not recommended to avoid adverse drug reactions. However, it is unclear how much such treatment cases exist in real world clinical settings. This is because no long-term investigation has been carried out. Materials and Methods:This study investigated treatment with these drugs from 2005 to 2017, by studying 1135 patients with MAC lung disease based on health insurance claims database.Results: Results showed that approximately 9.2% (101 cases) were prescribed longterm CAM monotherapy for 3 months or longer and approximately 3.6% (18 cases) were prescribed high doses of EB. Conclusion: CAM monotherapy over a long period of time is potentially detrimental to some patients. Better awareness of the types of treatments and their potential negative effects will be beneficial to clinical practitioners. K E Y W O R D S clarithromycin monotherapy, ethambutol, insurance claims database, Mycobacterium avium-intracellulare complex, nontuberculous mycobacteriosis, pharmacoepidemiology

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Section: Discussionmentioning

confidence: 99%

A survey of clarithromycin monotherapy and long‐term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims

Iwao

Kato

Ito

et al. 2019

Pharmacoepidemiology and Drug

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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%

“…Since the most common presentation is retro bulbar neuritis fundal examination may be normal. 7 Central fibres are affected generally which causes a decrease in visual acuity and central scotoma. But rarely peripheral fibres can also be affected, presenting as peripheral field constriction.…”

Section: Discussionmentioning

confidence: 99%

“…It can progress to optic atrophy which manifests as temporal pallor of the disc during fundoscopic examination. 7,12 Ethambutol induced optic neuritis is usually reversible, once the drug is withdrawn and recovery is time consuming. 6 Irreversible cases of ethambutol induced optic neuritis have also been reported especially with advancing age.…”

Section: Discussionmentioning

confidence: 99%

“…There are several postulates put forward one such postulate is that ethambutol and its metabolite have a zinc chelating effect causing dysregulation of retinal homeostasis. 7,12 Ethambutol is also said to interfere with iron containing complex I and copper containing complex IV and thus disrupting the oxidative phosphorylation and generating reactive oxygen species leading to retinal ganglion cell damage. 7 Here we are discussing four cases of ethambutol induced optic neuritis.…”

Section: Discussionmentioning

confidence: 99%

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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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Manifestations of Drug Toxicity on Mitochondria in the Nervous System

Prehn

Llorente‐Folch

2018

Mitochondrial Dysfunction Caused by Drugs and Environmental Toxicants

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Ocular toxicity with ethambutol therapy: Timely recaution

Cited by 37 publications

References 25 publications

A survey of clarithromycin monotherapy and long‐term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims

A survey of clarithromycin monotherapy and long‐term administration of ethambutol for patients with MAC lung disease in Japan: A retrospective cohort study using the database of health insurance claims

Ethambutol induced optic neuritis: a case series

Manifestations of Drug Toxicity on Mitochondria in the Nervous System

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