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Ethambutol kinetics in patients with impaired renal function
The American Review of Respiratory Disease
|July 1, 1986
Summary
Ethambutol (EMB) elimination slows significantly in patients with kidney problems, requiring dosage adjustments. Creatinine clearance predicts EMB drug clearance, aiding safe treatment for tuberculosis patients with renal impairment.
Area of Science:
- Pharmacokinetics
- Nephrology
- Infectious Diseases
Background:
- Ethambutol (EMB) is a key drug in tuberculosis treatment.
- Renal function significantly impacts drug pharmacokinetics.
- Understanding EMB elimination in renal impairment is crucial for safe dosing.
Purpose of the Study:
- To investigate the pharmacokinetics of ethambutol in patients with varying degrees of renal dysfunction.
- To determine the relationship between renal function parameters and EMB elimination.
- To provide guidance on EMB dosage adjustments in renally impaired patients.
Main Methods:
- 13 hospitalized patients with compromised renal function received a 15 mg/kg EMB infusion.
- Plasma and urine samples were collected over 24 and 96 hours, respectively.
- EMB concentrations were analyzed using electron capture gas-liquid chromatography.
Main Results:
- Plasma EMB concentrations declined multi-exponentially with a terminal half-life of 7.4–11.8 hours.
- Total body clearance ranged from 2.0–9.6 ml/min/kg; renal clearance varied from 0.07–0.57 ml/min/kg.
- Elimination rate constant significantly correlated with creatinine clearance and inverse serum creatinine.
Conclusions:
- Renal failure decreases EMB total body and renal clearance, prolonging its elimination half-life.
- Creatinine clearance or serum creatinine levels can predict a patient's capacity to eliminate EMB.
- Mandatory dosage adjustment of EMB is essential for patients with compromised renal function to ensure optimal therapy and prevent adverse effects.