Ethambutol

Generic name
Ethambutol
Brand name
ATC Code
J04AK02

Ethambutol

Dosages
Side effects in children
Warnings & precautions in children
Contra-indications in children

Interactions
PK
Renal impairment
References

Pharmacokinetics in children

No information

dose recommendation of formulary compared to licensed use (on-label versus off-label)

No information is present at this moment.

Available formulations

No information is present at this moment.

Dosages

Tuberculosis
  • Oral
    • 1 month up to 12 years
      [4]
      • 15 - 25 mg/kg/day in 1 dose. Max: 1.6 g/day.
    • 12 years up to 18 years
      [3] [6]
      • 15 - 20 mg/kg/day in 1 dose. Max: 1.600 mg/day.
  • Intravenous
    • 1 month up to 18 years
      [6]
      • 15 - 25 mg/kg/day in 1 dose. Max: 1.6 g/day.
Infection by atypical mycobacteria (e.g. lymphadenitis colli)
  • Oral
    • 1 month up to 18 years
      • 15 mg/kg/day in 1 dose
      • In combination with clarithromycin.

Renal impaiment in children > 3 months

  • GFR ≥ 50: dose adjustment not necessary.
  • GFR 10-30: 100% of normal reversal dose, 3x per week, guided by ethambutol level.
  • GFR <10: 100% of normal reversal dose, 3x per week, guided by ethambutol level.
Clinical consequences

With impaired renal function, the half-life of ethambutol is prolonged. This increases the risk of adverse reactions.

Clinical effects:
Neuritis optica may occur, especially with daily doses from 25 mg/kg body weight (dose-dependent toxicity), with prolonged use, in renal impairment, or in diabetic patients with retinopathy. The symptoms are decreased visual acuity, disturbed color sense (especially red-green) and partial loss of visual field. These symptoms are usually reversible with immediate discontinuation of therapy; failure to discontinue in a timely manner may result in blindness.

The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here

Side effects in children

Hepatotoxicity and neuropathies.

The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here

Contra-indications

No information available on specific contra indications in children.

The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here

Warnings & precautions in children

Regular checks of the eyes are recommended because of the potential for optic neuritis to occur.

It has been observed in multiple studies that ethambutol levels in children are on average lower than in adults receiving the same dosage per kg body weight. This may be caused by decreased absorption in children compared with adults. Monitoring of the ethambutol levels is desirable when treating children.(SmPC)

Interactions

The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here

DRUGS FOR TREATMENT OF TUBERCULOSIS

This pages provides a list of drugs from the same ATC class for comparison. This does not necessarily mean that these drugs are interchangeable.

Antibiotics
J04AB02
Hydrazides
J04AC01
Other drugs for treatment of tuberculosis
J04AK05
J04AK06
J04AK01

References

  1. Hartwig NC, et al, Vademecum pediatrische antimicrobiële therapie, 2005
  2. Furth van AM et al, Werkboek Infectieziekten bij Kinderen, VU Uitgeverij, 1999
  3. Teofarma, SmPC Myambutol (RVG 06455) 28-12-2015, www.geneesmiddeleninformatiebank.nl
  4. NVALT, Richtlijn medicamenteuze behandeling van tuberculose, 2 okt 2014
  5. NKFK Workinggroup Acute Kidney Impairment, Extrapolation of KNMP risk analysis "Impaired renal function" for adults to children, 20 Dec 2021
  6. Esteve Pharmaceuticals GmbH, SmPC EMB-Fatol (6193016.00.02), 11/2021

Changes

Therapeutic Drug Monitoring


Overdose