Sural

• Pulmonary Tuberculosis: Used for the treatment of pulmonary tuberculosis. Should not be used as the sole antituberculous drug, but should be used in conjunction with at least one other antituberculous drug.
• Extrapulmonary Tuberculosis: Used for the treatment of tuberculosis outside the lungs.

Ethambutol appears to inhibit the synthesis of 1 or more metabolites in susceptible bacteria resulting in impairment of cellular metabolism, arrest of multiplication, and cell death. It is active against susceptible bacteria only when they are undergoing cell division.

Adult Dose (Oral):

• Initial treatment (no prior therapy): 15 mg/kg/day or 30 mg/kg thrice weekly (with isoniazid, rifampicin and pyrazinamide).
• Retreatment (history of antimycobacterial therapy): Initial: 25 mg/kg/day for 60 days, then reduce to 15 mg/kg/day.

Child Dose: 15-25 mg/kg, max 2.5 g q24h; Drug-resistant TB: 15-25 mg/kg daily or 50 mg/kg twice weekly.

Renal Dose: Dose adjustment may be needed as determined by blood levels.

Common Side Effects:

• Visual impairment
• Color blindness (green-red color blindness)
• Retrobulbar neuritis
• Constriction of visual field
• Central or peripheral scotoma

Other Side Effects:

• Confusion, disorientation, hallucinations
• Headache, dizziness, malaise
• Jaundice or transient liver dysfunction
• Peripheral neuropathy
• Thrombocytopenia
• GI disturbances (nausea, vomiting, anorexia, abdominal pain)
• Allergic reactions (rash, pruritus, fever)

Use in Pregnancy: Category C. Animal studies have shown adverse effects on the fetus. Should be used only if potential benefit justifies potential risk to the fetus.

Precautions:

• Ethambutol may cause sight problems and tingling or numbness in hand or feet; do not drive until you know how it affects you.
• It has to be taken for several months in order for it work properly (usually 6 months).
• Take with food to avoid stomach upset.
• Can lower blood sugar; monitor blood sugar regularly if diabetic.
• Your doctor may monitor liver function, vision and thyroid function.
• Do not stop taking even if you start to feel better (early stopping can lead to treatment failure and drug-resistant TB).
• Caution in patients with ocular defects, renal impairment.

Overdose: Overdose may cause visual impairment. In case of overdose, symptomatic treatment should be given and seek immediate medical attention.

Storage: Store between 20-25 degree C. Protect from light, moisture and excessive heat.