Pharmacoepidemiol Risk Manage.  2024 Sep;16(2):124-134. 10.56142/perm.24.0015.

Monitoring Ethambutol-Induced Optic Neuropathy in Tuberculosis Treatment: A Systematic Review of Guidelines and Recommendations

• An S
• Kim J

• KMID: 2564477
• DOI: http://doi.org/10.56142/perm.24.0015

Abstract

Tuberculosis remains a significant public health issue globally despite being preventable and treatable. This study reviews domestic and international tuberculosis treatment guidelines, focusing on recommendations for preventing ethambutol-induced optic neuropathy, a serious side effect of a key anti-tuberculosis drug. This study reviews tuberculosis treatment guidelines published between January 2015 and June 2024, focusing on recommendations for managing ethambutol-induced optic neuropathy. A systematic search was conducted using major databases and health organization websites. Guidelines were selected based on specific criteria and evaluated using the AGREE II instrument, with strengths and limitations analyzed to identify potential improvements in monitoring strategies. This study analyzed six international and one domestic tuberculosis treatment guideline using the AGREE II instrument. Guidelines varied in development rigor and transparency, with WHO and ATS/CDC/IDSA guidelines demonstrating the most comprehensive methodologies. Four guidelines, including the domestic one, addressed ethambutol-induced visual impairment, recommending baseline and periodic vision assessments. Recommendations for monitoring and managing ocular side effects varied across guidelines, emphasizing the importance of patient education and prompt reporting of visual changes. Out of seven guidelines examined, only four, including the domestic guideline, provided specific recommendations. The study emphasizes the importance of early detection and prevention of permanent visual impairment, suggesting the need for more detailed criteria, monitoring frequencies, and advanced diagnostic methods, particularly for high-risk patients. Selective use of optical coherence tomography and angiography is recommended for early diagnosis and prevention of irreversible disability.

Keyword

Ethambutol; Toxic optic neuropathy; Tuberculosis; Guidelines; Tomography; Optical coherence