Is pyrazinamide really the third drug of choice in the treatment of tuberculosis?

SETTING

University Hospital in a rural area of Greece.

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.