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Free Content Ethambutol dosage for the treatment of children: literature review and recommendations [Review Article]

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The currently recommended daily dose of ethambutol (EMB) for the treatment of tuberculosis (TB) in children varies from a maximum daily dose of 15 mg/kg body weight daily (without a range) to 15–20 mg/kg and 20 mg/kg (range 15–25 mg/kg). Published evidence relating to the dosage, toxicity and pharmacokinetics of EMB in children and adults is reviewed and a dose of EMB for use in childhood is recommended. Using key words ‘ethambutol’, ‘childhood’, ‘TB’, ‘pharmacokinetics’, ‘bioavailability’ and ‘toxicity’, Medline searches were conducted; cross-references were sought from original papers, books and conference proceedings dating from 1961. When English summaries were available, data were extracted from papers in languages other than English.

EMB has a dose-related efficacy best seen when given to adults alone or with a single other drug. Together with isoniazid (INH), a dose of 15 mg/kg EMB gave better results than 6 mg/kg, and 25 mg/kg better than 15 mg/kg. The occurrence of ocular toxicity was also dose-related; >40% of adults developed toxicity at doses of >50 mg/kg, and 0–3% at a dose of 15 mg/kg/daily. Peak serum EMB concentrations increase in relation to dose, but are significantly lower in children receiving the same dosage. In only 2 of 3811 children (0.05%) receiving EMB doses of 15–30 mg/kg was EMB stopped due to possible ocular toxicity; children of all ages can be given EMB in daily doses of 20 mg/kg (range 15–25 mg/kg) and three times weekly intermittent doses of 30 mg/kg body weight without undue concern.
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Keywords: childhood; dosage; ethambutol; toxicity; tuberculosis

Document Type: Review Article

Affiliations: 1: Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa 2: Stop TB Department, World Health Organization, Geneva, Switzerland 3: Biostatistics Unit, Medical Research Council of South Africa, Tygerberg, South Africa 4: Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland

Publication date: December 1, 2006

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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