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Published ahead of print on April 28, 2005, doi:10.1164/rccm.200407-863OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 2, July 2005, 250-253

A more recent version of this article appeared on July 15, 2005
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Submitted on July 5, 2004
Accepted on April 25, 2005

Ethambutol Ocular Toxicity in Treatment Regimens for Mycobacterium avium Complex Lung Disease

David E Griffith1*, Barbara A Brown-Elliott1, Sara Shepherd1, Jerry McLarty2, Lee Griffith1, and Richard J Wallace, Jr1

1 Departments of Medicine and Microbiology, University of Texas Health Center, Tyler, TX, United States, 2 Louisiana State University Health Science Center, Shreveport, LA, USA

* To whom correspondence should be addressed. E-mail: david.griffith{at}uthct.edu.

Ethambutol is an important component of multidrug treatment regimens for Mycobacterium avium complex lung disease. Ocular toxicity is the most important potential ethambutol toxicity, especially in the elderly population with Mycobacterium avium complex lung disease. Two hundred twenty-nine patients with Mycobacterium avium complex lung disease, 55% women and 53% with nodular/bronchiectatic disease, received a mean of 16.1 ± 10.8 months of multidrug therapy that included ethambutol. 50 patients (22%) were known to have pre-existing ocular disease. While on ethambutol, 97 (42%) patients consulted an opthalmologist and 24 (10%) stopped ethambutol at least temporarily. Eight of 139 patients (6%) on daily therapy were diagnosed with ethambutol ocular toxicity while 0/90 patients on intermittent therapy had ethambutol ocular toxicity (p=0.05). All patients with ethambutol ocular toxicity developed symptoms between outpatient clinic appointments; none were diagnosed with routine visual acuity and color vision testing. All patients with ethambutol ocular disease returned to baseline ocular status after discontinuation of EMB. Intermittent ethambutol administration was associated with less ocular toxicity than daily ethambutol administration in this patient population.
Key words: Ethambutol, Mycobacterium avium complex




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