ABSTRACT

Treatment of active and latent tuberculosis has evolved steadily over the 70 years since the dawn of the antibiotic era with 25 drugs from many distinct classes now in common use in different clinical situations. Pyrazinamide is expected to cause clinically significant drug interactions but should be used with caution with other potentially hepatotoxic drugs and drugs acting on uric acid metabolism. Hypokalemia and hypomagnesemia are more common than with the aminoglycosides. Eosinophilia is described on daily dosing and leuko and thromobocytopenia and raised liver enzymes may also occur. No dosage adjustments are suggested in renal failure but para-Aminosalicylic acid (PAS) is considered relatively contraindicated in severe renal disease due to possible accumulation of the N-acetyl metabolite. Removal of PAS by hemodialysis is only 6%. The drug should also be used with caution in advanced liver disease. Twice daily dosing at 300 mg may offer similar efficacy with fewer adverse effects but few comparative clinical data exist.