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Concerning rifabutin see p. 274. Ethambutol. The cause of its specific antitubercular action is unknown. Ethambutol is given orally. It is generally well tolerated, but may cause dosedependent damage to the optic nerve with disturbances of vision (red/green blindness, visual field defects). Pyrazinamide exerts a bactericidal action by an unknown mechanism. It is given orally.
Uses. The quaternary carbamate neostigmine is employed as an indirect parasympathomimetic in postoperative atonia of the bowel or bladder. Furthermore, it is needed to overcome the relative ACh-deficiency at the motor endplate in myasthenia gravis or to reverse the neuromuscular blockade caused by nondepolarizing muscle relaxants (decurarization before discontinuation of anesthesia).


In these forms of rhythm disorders, antiarrhythmics of the local anesthetic, Na+-channel blocking type (B) are used for both prophylaxis and therapy. Local anesthetics inhibit electrical excitation of nociceptive nerve fibers; concomitant cardiac inhibition (cardiodepression) is an unwanted effect. However, in certain types of arrhythmias (see above), this effect is useful.
All newer agents are rather well tolerated. Plasmodium (P. ) falciparum, responsible for the most dangerous form of malaria, is particularly prone to develop drug resistance. The incidence of resistant strains rises with increasing frequency of drug use. Resistance has been reported for chloroquine and also for the combination pyrimethamine/ sulfadoxine.


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