Pyrazinamide is an antimycobacterial agent used in the treatment of Tuberculosis. It is a first-line agent used in triple therapy with Isoniazid and Rifampicin or quadruple therapy with the addition of Ethambutol. Pyrazinamide cannot be used alone as it is only weakly bacteriocidal.

It is a synthetic analogue of nicotinamide and is believed to inhibit mycobacterial fatty acid synthase I. This essentially prevents reproduction.

Use of the drug is strongly associated with Hepatitis and can cause fulminant Hepatic failure. It should not be used for longer than 2 months. Patients should undergo full liver function testing before starting treatment and this should continue to be carefully monitored. Pyrazinamide also inhibits urate excretion and can therefore cause Gout.

British National Formulary v.54
Brunton et al. Goodman & Gilman's The Pharmacological Basis of Therapeutics 11th edition.

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