by Tikiso T, McIlleron H, Abdelwahab MT, Bekker A, Hesseling A, Chabala C, Davies G, Zar HJ, Rabie H, Andrieux-Meyer I, Lee J, Wiesner L, F Cotton MF, Denti P. Journal of Antimicrobial Chemotherapy 2022; 77(7):1949–1959. doi: 10.1093/jac/dkac127
Summary: Ethambutol protects against the development of resistance to co-administered drugs in the intensive phase of first-line anti-TB treatment in children. It is especially relevant in settings with a high prevalence of HIV or isoniazid resistance. The authors describe the population pharmacokinetics of ethambutol in children with TB in order to guide dosing. Data was pooled from 188 intensively sampled children from the DATiC, DNDi and SHINE studies, who received 15–25 mg/kg ethambutol daily according to WHO guidelines. The authors conclude that to obtain exposure within the recommended range, the current doses must be doubled (or tripled with HIV+ children on lopinavir/ritonavir) for paediatric patients. This raises concerns regarding the potential for ocular toxicity, which would require evaluation.