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HIV Guide
 Zambia HIV National Guidelines
 


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General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents  

When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents  

Initial Regimen for ARV Therapy  

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Baseline evaluation and Monitoring  

Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance  

ARV Therapy for Individuals with Tuberculosis Co-Infection  

Adverse Effects and Toxicity  

Immune Reconstitution Inflammatory Syndrome (IRIS)  

Changing or Stopping ART  

Treatment Failure  

Stopping ARV Therapy  

Post Exposure Prophylaxis  

Cotrimoxazole Prophylaxis  

WHO Staging in Adults and Adolescents  

Nutrition Care and Support  

Palliative Care in HIV and AIDS  

 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Ethambutol

Paul A. Pham, Pharm.D. and John G. Bartlett, M.D.
03-30-2008

  • Available formulation in Zambia: Tablet: 100-400 mg (hydrochloride). Isoniazid + ethambutol tablet: 150 mg + 400 mg. Rifampicin + isoniazid + ethambutol tablet: 150 mg + 75 mg + 275 mg. Rifampicin + isoniazid + pyrazinamide + ethambutol tablet: 150 mg + 75 mg + 400 mg + 275 mg.
  • All new TB cases (smear positive, smear negative, extra-pulmonary TB, and smear negative relapse): INH, RIF, PZA, and EMB x 2 months, then INH plus EMB x 6 months.
  • TB smear positive re-treatment cases (e.g treatment failure, treatment after default, smear positive relapse): INH, RIF, PZA, EMB, and SM x 2 months, then INH, RIF, PZA, and EMB x 6 months.
  • MAC: Ethambutol 15-20 mg/kg/day plus clarithromycin. Rifabutin not available or recommended.
  • MDRTB standardized regimen: ethambutol 800mg/d (<50kg); 1200 mg (>50kg) plus ethionamide, kanamycin, ofloxacin, and pyrazinamide x 4 month, then based on culture conversion and sensitivity, continue with ethionamide, ofloxacin, and ethambutol for 12-18 months.

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • Treatment of all forms of TB in combination with other antituberculous drugs.
NON-FDA APPROVED USES

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
Myambutol Ethambutol (EMB)Elanoral
tablet
100 mg
$0.68
      oral 
tablet
400 mg
$1.78

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

  • TB: 15-20 mg/kg (max 2gm) qd (plus INH, PZA, Rifamycin)
  • Intermittent directly-observed treatment regimens: 50 mg/kg 2x/wk (max 4g) or 25-30 mg/kg 3x/wk (max 2.4 g).
  • MAC: 15mg/kg/d (plus macrolide)
  • M. kansasii: 25 mg/kg/d x 2 mos then 15 mg/kg/d (max 2.5 gm/d) (plus INH and Rifamycin)

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

15 mg/kg/ q24h (consider dose reduction with clearance <70 mL/min).

DOSING FOR GLOMERULAR FILTRATION OF 10-50

15 mg/kg/ q24-36h.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

15 mg/kg/ q48h.

DOSING IN HEMODIALYSIS

15-20 mg/kg/day post-HD 3x/wk.

DOSING IN PERITONEAL DIALYSIS

15 mg/kg/48 hrs.

DOSING IN HEMOFILTRATION

No data. Consider dose reduction.

ADVERSE DRUG REACTIONS

OCCASIONAL

  • Optic neuritis: decreased acuity, reduced color discrimination, constricted fields, and scotomata (infrequent with 15 mg/kg/d; inc risk w/ 25 mg/kg/d). Pts receiving 25 mg/kg/d should have baseline visual and color perception screening; repeated visual screening monthly. Ocular manifestation reversible with discontinuation, but irreversible blindness has been described.
  • GI intolerance: anorexia, nausea, vomiting, and abdominal pain.
RARE

  • Peripheral neuropathy.
  • Hypersensitivity reaction.
  • Confusion and dizziness.
  • Acute gout.
  • Hematologic: leukopenia, thrombocytopenia, eosinophilia, neutropenia, and lymphadenopathy.
  • Dermatologic: rash, pruritus, dermatitis, and exfoliative dermatitis.
  • Interstitial nephritis.

DRUG INTERACTIONS

SPECTRUM

Detailed Spectrum of Activity

PHARMACOLOGY

Pharmacology

COMMENTS

First line agent in combination for TB and MAC. Monitor visual acuity in pts receiving higher doses (25 mg/kg/d).

REFERENCES

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