Is pyrazinamide really the third drug of choice in the treatment of tuberculosis?
Objective: Pyrazinamide (PZA) is recommended as the third drug in the 6-month regimens for tuberculosis. This has replaced previously satisfactory 9-month regimens with ethambutol (EMB). Several cases of severe hyperuricemia and at least one episode of acute arthritis in patients receiving PZA prompted us to study PZA prospectively with regard to these side effects.
Design and Subjects: Prospective study of 20 patients receiving PZA for tuberculosis compared to control patients with tuberculosis not receiving PZA.
Results: The study was discontinued with the twentieth patient when it became obvious that uric acid was elevated in all patients while on PZA and the last patient developed acute arthritis. This occurred in none of the control patients.
Conclusion: Hyperuricemia should either be considered a significant side effect and make us reconsider PZA as the third drug of choice in tuberculosis, or it should be officially declared trivial by a major health organization. If so, it should be suggested to all health providers involved that there is no need to monitor uric acid in tuberculosis patients receiving PZA.
Keywords: gout; hyperuricemia; pyrazinamide; tuberculosis
Document Type: Regular Paper
Affiliations: Department of Pneumonology, Medical School University of Ioannina, Ioannina, Greece
Publication date: 01 August 1998
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