• Highly effective during 1st 2months
  • Active both intra & extracellularly 
  • First line ATT in children Streptomycin & Pyrazinamide
  • Including Z in combination therapy -duration of treatment is ↓ 
  • It has potent sterilising action 
  • Risk of relapse is reduced 
  • Good CSF Penetration
  • Bactericidal drug
  • Pyrazinamide Mycobacterial →Pyrazinamidase pncA→ Pyrazinoic Acid→ Inhibits Plasma membrane Synthesis
  • Arthralgia.
  • Hepatitis.
  • Hyperuricemia (precipitate gout)
  • Fever,Flushing, rashes, loss of diabetes control.
  • Rare Adverse effects 
  1. Gastrointestinal reactions 
  2. Cutaneous reactions 
  3. Sideroblastic anaemia.
  • For joint involvement, simple treatment with analgesics 
  • Indomethacin - for more severe joint involvement 
  • Colchicine 
  • Arthralgia is less common with thrice-weekly treatment 
  • Asymptomatic elevation of serum uric acid
Exam Question
  • Pyrazinamide is a bactericidal drug
  • Hyperuricemia is a recognized side effect of pyrazinamide
  • Pyrazinamide precipitate gout
  • Pyrazinamide is Anti-tubercular drug not given in liver disease 
  • First line ATT in children Streptomycin & Pyrazinamide
  • Maximum liver toxicity is seen with Pyrazinamide anti -TB drug
Don't Forget to Solve all the previous Year Question asked on PYRAZINAMIDE