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Ethionamide requires activation by the mycobacterial enzyme flavin monooxygenase (EthA) and the transcriptional repressor EthR to form ethionamide sulfoxide, which binds to NAD + and inhibits the enoyl-acyl carrier protein reductase (InhA), thereby blocking mycolic acid synthesis, responsible for cell death ( Ethionamide is extensively metabolized in the liver, mainly through flavin-containing monooxygenase (FMO3)

This regulation has also clearly stated regarding the stamps

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But with repeated exposure, those cells begin to change

When exposed to CO, the gel changes color, which is detected by an optical sensor