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Background. Ethambutol is renally cleared, but whether it is removed by haemodialysis is uncertain. No consensus guidelines exist on dosing ethambutol in the haemodialysis-dependent patient despite the potential for toxicity, in particular optic neuritis. To address this problem and ascertain if ethambutol is dialysable, we measured serum ethambutol levels in such a patient. We aimed for a trough (pre-dialysis) level of< 1000 µg/l, and a peak level of 2000–6000 µg/l.

Methods. A 79-year-old Caucasian male was diagnosed with delayed disseminated Bacille Calmette-Guérin infection (BCG) secondary to intravesical BCG immunotherapy for bladder cancer 12 months prior. He was on thrice-weekly haemodialysis. Rifampicin, isoniazid and ethambutol were commenced for 6 months, with cessation of ethambutol after 2 months. Ethambutol was dosed post-dialysis. Levels were taken at 0, 1, 2, and 3 hours into a 4-hour …