TB Drugs:

Ethambutol

How do they work? “Action” Nursing management

Many antitubercular drugs are bacteriostatic against the M. • Ask the patient what he or she thinks causes the symptoms;
tuberculosis bacillus. These drugs usually act to inhibit bacterial promote health literacy by integrating the patient’s beliefs and
cell wall synthesis, which slows the multiplication rate of the fears into how the bacteria invades the body and how the
bacteria. Isoniazid is bactericidal, with rifampin and
drugs work to kill it.
streptomycin having some bactericidal activity.
• Discuss tuberculosis, its causes and communicability, and the
need for long-term therapy for disease control using simple,
non medical terms.
Indications • Review the drug therapy regimen, including the prescribed
drugs, doses, and frequency of administration.
• Treatment of TB in a protocol • Reassure the patient that various combinations of drugs are
effective in treating tuberculosis.
• Urge the patient to take the drugs exactly as prescribed and
Adverse reactions not to omit, increase, or decrease the dosage unless directed
to do so by the health care provider.
• Anaphylactoid reactions • Instruct the patient about possible adverse reactions and the
(unusual or exaggerated need to notify the prescriber should any occur.
allergic reactions)
• Arrange for direct observation therapy with the patient and
• Optic neuritis
• Dermatitis and pruritus family.
(itching) • Instruct the patient in measures to minimize gastrointestinal
• Joint pain upset.
• Anorexia • Advise the patient to avoid alcohol and the use of
• Nausea and vomiting nonprescription drugs, especially those containing aspirin,
unless use is approved by the health care provider.
• Reassure the patient and family that the results of therapy will
Contraindications & Caution be monitored by periodic laboratory and diagnostic tests and
follow-up visits with the health care provider.
Ethambutol is not recommended for patients with a history of
hypersensitivity to the drug or children younger than 13 years. The drug
is used with caution during pregnancy (category B), in patients with
hepatic or renal impairment, and in patients with diabetic retinopathy or Phases of treatment
cataracts. (Ford 105)
• The recommended treatment regimen is for the
administration of the primary drugs—rifampin (Rifadin),
Interactions isoniazid (INH), pyrazinamide, and ethambutol
(Myambutol)—for a minimum of 2 months
• Antacids containing aluminum
salts: Reduced absorption of isoniazid
• The second or continuation phase includes only the
• Anticoagulants: Increased risk for drugs rifampin and isoniazid. The CDC recommends this
bleeding phase for 4 months or up to 7 months in special
• Phenytoin: Increased serum levels of populations.
phenytoin
• Alcohol: Higher incidence of
drug-related hepatitis
Special populations
Nursing alert • Positive sputum culture after completion of initial
treatment
Older adults are particularly susceptible to a potentially fatal • Cavitary (hole or pocket of) disease and positive sputum
hepatitis when taking isoniazid, especially if they consume
alcohol on a regular basis. Two other antitubercular drugs, culture after initial treatment
rifampin and pyrazinamide, can cause liver dysfunction in the • When pyrazinamide was not included in the initial
older adult as well. Careful observation and monitoring for signs treatment
of liver impairment are necessary (e.g., increased serum • Positive sputum culture after initial treatment in a
aspartate aminotransferase [AST], alanine aminotransferase patient with previously diagnosed HIV infection
[ALT], and bilirubin levels, and jaundice). (Ford 107)

Generic Trade Use Dose

Ethambutol
Myambutol Pulmonary TB 15–25 mg/kg/day orally
Primary drug