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Fulltext Ethambutol ocular toxicity in a patient with pulmonary tuberculosis - a case report

Tan AK, Mallika P, Md Aziz S, Asokumaran T, Intan G

Malays Fam Physician, 2008;3(2):87-90.
PMID: 25606123 MyJurnal

Purpose. To highlight the importance of using the Farnsworth Panel D-15 Hue test in colour vision testing in patients on ethambutol treatment. Case Report. A 70 year-old lady received ethambutol as part of her anti-tuberculous regime. She developed blue-yellow colour defect detectable with the Farnsworth Panel D-15 Hue test, but not with the Isihara Pseudoisochromatic Plates. Ethambutol was immediately discontinued from her anti-tuberculous regime. Two months later, her colour vision returned to normal. Conclusion. This case report illustrates the importance of regular monitoring of patients receiving ethambutol for blue-yellow colour defect using the Farnsworth Panel D-15 Hue Test.

Matched MeSH terms: Ethambutol
Fulltext Mycobacterium tuberculosis infection: demographic data and comparison of anti-tuberculosis susceptibility test

Nur Hidayah Masod, Noraziah Mohamad Zin, Alfizah Hanafiah

Sains Malaysiana, 2018;47:543-549.

Tuberculosis (TB) is a major health problem in many developing countries including Malaysia. In Malaysia, the number of death due to tuberculosis has decreased, but there is rising concern on the increase of drug resistance (multi drug resistance tuberculosis) cases. In this study, patients’ demographic data were analyzed and the susceptibility of Mycobacterium tuberculosis against anti-tuberculosis agents (isoniazid, streptomycin, rifampicin and ethambutol) was determined using susceptibility MYCOTB plates. A total of 40 clinical M. tuberculosis isolates, isolated from patients in PPUKM were randomly selected. Among these, 62.5% were male (mean age: 36.9±17.9 years) and 37.5% were female (mean age: 42.6±16.6 years). Malay patients accounted for the highest percentage of TB cases which was 60%, followed by Indians 15%, 5% Chinese and 20% other ethnics. The isolation of M. tuberculosis from clinical samples were 60%, 17.5%, 7.5%, 7.5%, 5% and 2.5% from sputum, tracheal aspirate, pus, blood, BAL and tissue, respectively. This is correlated with the majority of the patients (67.5%) infected with M. tuberculosis having persistent cough symptoms. The results from MYCOTB and BACTEC MGIT 960 susceptibility testing were compared. The average time taken to do the anti-TB susceptibility test by using MYCOTB plate and BACTEC MGIT 960 was 2 and 40.5 min, respectively. Cost per sample for MYCOTB and BACTEC MGIT 960 was RM16.65 and RM42.80, respectively. To conclude, based on our demographic data, TB infection was the highest amongst male Malay patients and the main specimens that been received was sputum sample. MYCOTB plate was more preferable than BACTEC MGIT 960 for the susceptibility testing and all clinical samples were 100% susceptible to all tested anti-TB agents. Data gathered from this study can be used as guideline for the management of TB diagnosis and treatment in the future.
Keywords: BACTEC MGIT 960; Mycobacterium tuberculosis; MYCOTB plate; tuberculosis

Matched MeSH terms: Ethambutol
Lupus vulgaris in an immunocompromised patient

Jalalonmuhali M, Lee YY, Lee CK, Ismail R, Chandran PA

Int J Dermatol, 2014 Feb;53(2):234-7.
PMID: 22913324 DOI: 10.1111/j.1365-4632.2012.05463.x
Matched MeSH terms: Ethambutol/therapeutic use
Fulltext A study of primary drug resistance in pulmonary tuberculosis in west Malaysia 1984-1987

Jalleh RD, Kuppusamy I, Soshila R, Aziah AM, Faridza MY

Med J Malaysia, 1993 Jun;48(2):113-6.
PMID: 8350784

Eight hundred and fifty-six strains of Mycobacterium tuberculosis from previously untreated patients with pulmonary tuberculosis from various states in West Malaysia were studied during the period 1984 to 1987. All the strains were tested for in vitro susceptibility to the anti-tuberculosis drugs isoniazid (INH), streptomycin (SM), rifampicin (RMP) and ethambutol (ETB). One hundred and twenty-one of the isolates (14.18%) were resistant to 1 drug while 17 (1.97%) were resistant to 2 drugs. No strain was found to be resistant to more than 2 drugs. The prevalence of primary resistance to INH was 4.20%, SM was 7.59%, RMP was 0.95% and ETB was 1.44%. In 1.86% of isolates, resistance was noted to both INH and SM, while 0.11% were resistant to both RMP and ETB. There was no significant difference in distribution of resistant bacilli between the sexes (p > 0.01).

Matched MeSH terms: Ethambutol/pharmacology*
Fulltext Nano-Formulation of Ethambutol with Multifunctional Graphene Oxide and Magnetic Nanoparticles Retains Its Anti-Tubercular Activity with Prospects of Improving Chemotherapeutic Efficacy

Saifullah B, Maitra A, Chrzastek A, Naeemullah B, Fakurazi S, Bhakta S, et al.

Molecules, 2017 Oct 12;22(10).
PMID: 29023384 DOI: 10.3390/molecules22101697

Tuberculosis (TB) is a dreadful bacterial disease, infecting millions of human and cattle every year worldwide. More than 50 years after its discovery, ethambutol continues to be an effective part of the World Health Organization's recommended frontline chemotherapy against TB. However, the lengthy treatment regimens consisting of a cocktail of antibiotics affect patient compliance. There is an urgent need to improve the current therapy so as to reduce treatment duration and dosing frequency. In this study, we have designed a novel anti-TB multifunctional formulation by fabricating graphene oxide with iron oxide magnetite nanoparticles serving as a nano-carrier on to which ethambutol was successfully loaded. The designed nanoformulation was characterised using various analytical techniques. The release of ethambutol from anti-TB multifunctional nanoparticles formulation was found to be sustained over a significantly longer period of time in phosphate buffer saline solution at two physiological pH (7.4 and 4.8). Furthermore, the nano-formulation showed potent anti-tubercular activity while remaining non-toxic to the eukaryotic cells tested. The results of this in vitro evaluation of the newly designed nano-formulation endorse its further development in vivo.

Matched MeSH terms: Ethambutol/pharmacology*; Ethambutol/chemistry*
An apparently healthy young man with a peculiar-looking chest radiograph

Khajotia R, Manthari K

Can Fam Physician, 2011 Mar;57(3):311-3.
PMID: 21402968
Matched MeSH terms: Ethambutol/therapeutic use
Fulltext Applicability of the World Health Organization recommended new shorter regimen in a multidrug-resistant tuberculosis high burden country

Javaid A, Ahmad N, Khan AH, Shaheen Z

Eur Respir J, 2017 01;49(1).
PMID: 28049176 DOI: 10.1183/13993003.01967-2016
Matched MeSH terms: Ethambutol/administration & dosage
Fulltext Novel Anti-Tuberculosis Nanodelivery Formulation of Ethambutol with Graphene Oxide

Saifullah B, Chrzastek A, Maitra A, Naeemullah B, Fakurazi S, Bhakta S, et al.

Molecules, 2017 Oct 12;22(10).
PMID: 29023399 DOI: 10.3390/molecules22101560

Tuberculosis (TB) is a bacterial disease responsible for millions of infections and preventable deaths each year. Its treatment is complicated by patients' noncompliance due to dosing frequency, lengthy treatment, and adverse side effects associated with current chemotherapy. However, no modifications to the half-a-century old standard chemotherapy have been made based on a nanoformulation strategy to improve pharmacokinetic efficacy. In this study, we have designed a new nanodelivery formulation, using graphene oxide as the nanocarrier, loaded with the anti-TB antibiotic, ethambutol. The designed formulation was characterized using a number of molecular analytical techniques. It was found that sustained release of the drug resulted in better bioavailability. In addition, the designed formulation demonstrated high biocompatibility with mouse fibroblast cells. The anti-TB activity of the nanodelivery formulation was determined using whole-cell resazurin microtiter plate assay, modified-spot culture growth inhibition assay, and biofilm inhibition assay. The nanodelivery formulation showed good anti-mycobacterial activity. The anti-mycobacterial activity of Ethambutol was unaffected by the drug loading and release process. The results of this study demonstrated the potential of this new nanodelivery formulation strategy to be considered for modifying existing chemotherapy to yield more efficacious antibiotic treatment against TB.

Matched MeSH terms: Ethambutol/administration & dosage*
Fulltext A rare case of TB elbow synovitis in a patient with rheumatoid arthritis: a case report

Meryl Grace Lansing, Malehah Mohd Noh, Mohd Hakimi Nordin

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):96-96.
MyJurnal

Introduction: Tuberculosis (TB) of the elbow joint is uncommon. Prompt diagnosis and treatment are important to prevent joint destruction and preserve function. We present a case of TB synovitis of the elbow joint in a patient with active rheumatoid arthritis (RA). Case description: A 56-year-old woman with a known seropositive RA on metho-trexate and Leflunomide was seen in the outpatient rheumatology clinic as part of her monthly follow-up. She com-plained of persistent bilateral elbow pain and swelling, despite optimisation of her disease-modifying antirheumatic drugs (DMARD) and steroid therapy. The suspicion for another diagnosis for her elbow symptoms stems from the persistent pain and swelling amidst increased titration of methotrexate and prednisolone dosages. Ultrasound scan of her elbows revealed bilateral complex olecranon bursitis with active synovitis. The left elbow aspiration yielded cloudy yellowish synovial fluid and the sample was sent for fluid culture, acid-fast bacilli (AFB) stain, and GeneXpert. No AFB was seen but the GeneXpert test confirmed the presence of Mycobacterium Tuberculosis. Thus, a diagnosis of TB synovitis of the left elbow was made, and she was promptly started on anti-tubercular therapy (ATT) consisting of Rifampicin, Isoniazid, Ethambutol and Pyrazinamide with the aim to complete 9 months of ATT. Conclusion: The diagnosis of tuberculous synovitis is challenging. In the absence of constitutional or respiratory symptoms, joint TB is usually low on the initial differential diagnosis in patients presenting with joint pain and swelling. The diagnosis is made even more difficult in patients with concomitant rheumatoid arthritis. This case demonstrates the importance of a high index of suspicion for TB, particularly when evaluating patients in high TB prevalence area with an underlying immunosuppressive state.

Matched MeSH terms: Ethambutol
Fulltext A double-edged sword: a case report on liver injury side-effect of anti-tuberculosis drug on liver tuberculosis patient

Azlina Ibrahim, Alvin Oliver Payus

Borneo Journal of Medical Sciences, 2020;14(1):49-53.
MyJurnal

Hepatic involvement in extra-pulmonary tuberculosis (TB) is rare, even in the endemic area. It has a high mortality rate as it can easily be misdiagnosed due to its rarity and non-specific presentations, and the treatment can be challenging for its hepatotoxic side-effect. A 55-year old man who was newly diagnosed with AIDS and pulmonary TB which complicated with anti-TB-induced transaminitis, presented with a few weeks history of fever and persistent diarrhoea. It was initially treated as microsporidia infection but the symptoms persisted despite given antiparasitic agent for more than a week. He was subjected to computed tomography (CT) scan of the abdomen and noted multiple hypoechoic lesion at multiple segments of the liver, which later confirmed to be liver TB by liver biopsy. As he could not tolerate Akurit-4 (Rifampicin 150 mg, Isoniazid 75 mg, Pyrazinamide 400 mg and Ethambutol 275 mg), the second-line treatment was given instead. He is currently well on regular clinic appointment. The objective of this case report is to share the rare occurrence of hepatic TB and the difficulty to treat it as the hepatotoxic effect of anti-TB medications complicate the liver damage due to the infection.

Matched MeSH terms: Ethambutol
Fulltext Treating More with Less: Effectiveness and Event Outcomes of Antituberculosis Fixed-dose Combination Drug versus Separate-drug Formulation (Ethambutol, Isoniazid, Rifampicin and Pyrazinamide) for Pulmonary Tuberculosis Patients in Real-world Clinical Practice

Lai JML, Yang SL, Avoi R

J Glob Infect Dis, 2019 3 1;11(1):2-6.
PMID: 30814828 DOI: 10.4103/jgid.jgid_50_18

Introduction: Conventionally, a combination of four separate drugs (ethambutol, isoniazid, rifampicin, and pyrazinamide [EHRZ]) is the first-line pharmacotherapy for pulmonary tuberculosis (TB). In recent years, fixed-dose combination (FDC) formulation, where a single tablet contains the active ingredients of four aforementioned drugs, is gaining popularity due to its ease of administration.
Objective: To compare the real-world effectiveness of EHRZ and FDC treatment groups on a cohort registry by investigating the sputum conversion rate and treatment outcomes of both groups.
Methods: A total of 11,489 patients' data were extracted from the Sabah TB registry between January 2012 and June 2016, including EHRZ (n = 4188) and FDC (n = 7301) patients. Then, 1:1 propensity score matching was adopted to reduce the baseline bias. Caliper matching was conducted with maximum tolerance score set at 0.001. Confounders included in the propensity score matching were gender, nationality, diabetes, HIV status, smoking status, and chest X-ray status. Successful matching provided 4188 matched pairs (n = 8376) for final analysis.
Results: In this matched cohort of 4188 pairs, the 2-month sputum conversion rate of FDC group was significantly higher than the EHRZ group (96.3% vs. 94.3%; P < 0.001) whereas 6-month sputum conversion of both groups showed no significant difference. Treatment outcomes such as noncompliance rate, failure rate, and success rate have no significant difference (P > 0.05) in both the treatment groups. There was an incidental finding of reduced death rate among FDC group compared to the EHRZ group (0.2% vs. 0.5%; P = 0.034).
Conclusion: The FDC formulation has better sputum conversion rate at 2 months compared to conventional EHRZ regime as separate-drug formulation. It was also observed that FDC has a slight protective effect against all-cause death among TB patients. This protective effect of FDC, however, still needs to be proven further.

Matched MeSH terms: Ethambutol