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Ординатура / Офтальмология / Английские материалы / Clinical Ocular Toxicology Drug-Induced Ocular Side Effects_Fraunfelder, Chambers _2008.pdf
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Sanchez-Perez J, Lopez MP, De Vega Haro JM, Garcia-Diez A. Allergic

it appears that stopping the drug can prevent progression to

contact dermatitis from gentamicin in eyedrops, with cross-reactivity

­blindness, and in some cases regression. Efforts are underway to

to kanamycin but not neomycin. Contact Dermatitis 44(1): 54, 2001.

find which patients are most susceptible to the neuropathy, how

Walsh FB, Hoyt WF. Clinical Neuro-Ophthalmology, Vol. III. 3rd edn.

to diagnose it early and possible ways to prevent this side effect.

Williams & Wilkins, Baltimore, pp 2655, 2680, 1969.

 

Generic name: Linezolid.

Proprietary name: Zyvox.

Primary use

A new class of synthetic antibiotics, oxazolidinones, for use in drug-resistant Gram-positive bacterial infections.

Ocular side effects

Systemic administration

Probable

1. Blurred or decreased vision

2. Decreased color vision

3. Visual field defects

a.Central scotomas

b.Centrocecal scotomas

4. Optic neuropathy (Fig. 7.1e)

a.Edema

b.Micro-hemorrhages

c.Atrophy

5. Blindness

Clinical significance

The use of this antibiotic is primarily in patients who have a drugresistant Gram-positive organism, often in a life-threatening ­circumstance. Ocular symptoms, while rare, are seldom seen in the first 28 days of therapy other than blurred vision. In patients requiring extended treatment, unrecognized drug-induced optic neuropathy could lead to bilateral blindness. To prevent this requires regular examinations, which include visual acuity, amsler grid testing, color vision and visual field tests. To date

Recommendations

1. If any visual changes occur, i.e. decreased or blurred vision, color vision abnormalities or any visual field change, the patient should see an ophthalmologist.

2. Perform an ophthalmic evaluation every 3 months if the patient remains on the drug for an extended period of time.

3. If diagnosis of optic neuropathy is suspected, a risk-benefit ratio is needed to determine if it is appropriate to continue the medication. Permanent visual loss, including legal blindness, has occurred if the drug is continued therefore informed consent is recommended.

4. Baseline ophthalmic examinations before starting this drug, including visual acuity, amsler grids, color vision testing and visual fields, while ideal, are probably not cost-effective.

References and Further Reading

Carallo CE, Paull AE. Linezolid-induced optic neuropathy. Med J Aust 177: 332, 2002.

De Vriese AS, Van Coster R, Smet J, et al. Linezolid-induced inhibition of mitochondrial protein sytnthesis. Clin Infect Dis 42: 1111–1117, 2006.

Ferr T, Pnceau B, Simon M, et al. Possibly linezolid-induced peripheral and central neurotoxicity: report of four cases. Infection 33(3): 151–154, 2005.

Frippiat F, Derue G. Causal relationship between neuropathy and prolonged linezolid use. Clin Infect Dis 39(3): 439, 2004.

Frippiat F, Bergiers C, Michel C, et al. Severe bilateral neuritis associated with prolonged linezolid therapy. J Antimicrob Chemother 53(6): 1114–1115, 2004.

Hernandez PC, Llinarea TF, Climent GE, Fernandez AC. Peripheral and optic­ neuropathy associated to linezolid in multidrug resistant Mycobacterium bovis infections. Medicinia Clinica 124(20): 797–798, 2005.

Mckinley SH, Foroozan R. Optic neuropathy associated with linezolid treatment. J Neuroophthalmol 25: 18–21, 2005.

Rucker JC, Hamilton SR, Bardenstein D, et al. Linezolid-associated toxic optic neuropathy. Neurology 66: 595–598, 2006.

Saijio T, Hayashi K, Yamada H, Wakakura M. Linezolid-induced optic neuropathy. Am J Ophthalmol 139(6): 1114–1116, 2005.

Fig. 7.1e  Bilateral temporal disc pallor from systemic linezolid treatment. Photo courtesy of Saijo T, et al: Linezolid-induced optic neuropathy. Am J Ophthalmol 139: 1114-1116, 2005.

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