IS PYRAZINAMIDE REALLY THE 3RD DRUG OF CHOICE IN THE TREATMENT OF TUBERCULOSIS

SETTING: University Hospital in a rural area of Greece. OBJECTIVE: Pyr azinamide (PZA) is recommended as the third drug in the 6-month regime ns 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 effe cts. DESIGN AND SUBJECTS: Prospective study of 20 patients receiving P ZA 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 pat ients while on PZA and the last patient developed acute arthritis. Thi s occurred in none of the control patients. CONCLUSION: Hyperuricemia should either be considered a significant side effect and make us reco nsider PZA as the third drug of choice in tuberculosis, or it should b e officially declared trivial by a major health organization. If so, i t should be suggested to all health providers involved that there is n o need to monitor uric acid in tuberculosis patients receiving PZA.