Individual generic drug information

pyrazinamide

Reference monograph

Part of registered formulation

PYRAZINAMIDE

Reference record: Pyrazinamide
Source: BNF 80 (2020–2021)
Printed source pages: 643, 644, 645, 646
Age groups indexed: 2

Individual active ingredientSource records are displayed separately

Some source sections could not be separated reliably in the extraction. Review the printed source pages when a field is missing or incomplete.

Overview

Extracted information for Pyrazinamide only.

Indications And Dose

Tuberculosis, in combination with other drugs (standard unsupervised 6-month treatment) ▶BY MOUTH ▶Child (body-weight up to 50 kg): 35 mg/kg once daily for 2 months (initial phase); maximum 1.5 g per day ▶Child (body-weight 50 kg and above): 35 mg/kg once daily for 2 months (initial phase); maximum 2 g per day ▶Adult (body-weight up to 50 kg): 1.5 g once daily for 2 months (initial phase) ▶Adult (body-weight 50 kg and above): 2 g once daily for continued → 2 months (initial phase) Tuberculosis, in combination with other drugs (intermittent supervised 6-month treatment) (under expert supervision) ▶BY MOUTH ▶Child (body-weight up to 50 kg): 50 mg/kg 3 times a week (max. per dose 2 g 3 times a week) for 2 months (initial phase) ▶Child (body-weight 50 kg and above): 50 mg/kg 3 times a Infection week (max. per dose 2.5 g 3 times a week) for 2 months (initial phase) ▶Adult (body-weight up to 50 kg): 2 g 3 times a week for 2 months (initial phase) ▶Adult (body-weight 50 kg and above): 2.5 g 3 times a week for 2 months (initial phase)

Source pages 643, 644

Contra Indications

Acute attack of gout (in adults)

Source page 644

Cautions

Diabetes. gout (in adults)

Source page 644

Prescribing And Dispensing Information

▶In children In general, doses should be rounded up to facilitate administration of suitable volumes of liquid or an appropriate strength of tablet. Doses may also need to be recalculated to allow for weight gain in younger children. The RCPCH and NPPG recommend that, when a liquid special of pyrazinamide is required, the following strength is used: 500 mg/5 mL.

Source page 644

Safety

Extracted information for Pyrazinamide only.

Interactions

→Appendix 1: pyrazinamide

Source page 644

Side Effects

Appetite decreased. arthralgia. dysuria. ﬂushing. gout aggravated. hepatic disorders. malaise. nausea. peptic ulcer aggravated. photosensitivity reaction . sideroblastic anaemia. skin reactions. splenomegaly. vomiting

Source page 644

Pregnancy

Manufacturer advises use only if potential beneﬁt outweighs risk.

Source page 644

Breast Feeding

Amount too small to be harmful.

Source page 644

Hepatic Impairment

Manufacturer advises avoid in severe impairment, acute hepatic disease and for up to 6 months after occurrence of hepatitis (risk of increased exposure).

Source page 644

Renal Impairment

Dose adjustments ▶In adults 25–30 mg/kg 3 times a week if eGFR less than 30 mL/minute/1.73 m2. ▶In children If estimated glomerular ﬁltration rate less than 30 mL/minute/1.73 m2, use 25–30 mg/kg 3 times a week. Monitoring Monitor for gout in renal impairment.

Source page 644

Monitoring Requirements

▶Renal function should be checked before treatment. ▶Hepatic function should be checked before treatment. If there is no evidence of liver disease (and pre-treatment liver function is normal), further checks are only necessary if the patient develops fever, malaise, vomiting, jaundice or unexplained deterioration during treatment. ▶In adults Those with alcohol dependence should have frequent checks of hepatic function, particularly in the ﬁrst 2 months.

Source page 644

Dose and formulations

Extracted information for Pyrazinamide only.

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Tablet CAUTIONARY AND ADVISORY LABELS 8 ▶Pyrazinamide (Non-proprietary) Pyrazinamide 500 mg Pyrazinamide 500mg tablets | 30 tablet P £40.06 DT = £40.06 ▶Zinamide (Genus Pharmaceuticals Ltd) Pyrazinamide 500 mg Zinamide 500mg tablets | 30 tablet P £31.35 DT = £40.06 Combinations available: Rifampicin with ethambutol, isoniazid and pyrazinamide, p. 617. Rifampicin with isoniazid and pyrazinamide, p. 618 2.6 Urinary tract infections Urinary-tract infections Description of condition Urinary-tract infections (UTIs) are common infections that can affect any part of the urinary tract. They occur more frequently in women, and are usually independent of any risk factor. UTIs are predominantly caused by bacteria from the gastrointestinal tract entering the urinary tract, with Escherichia coli being the most common cause. Infection due to Candida albicans is rare, but may occur in hospitalised patients who are immunocompromised or have an indwelling catheter. Lower UTIs are associated with inﬂammation of the bladder (cystitis) and urethra (urethritis). In some patients infection can ascend the urinary tract and lead to an upper UTI. Upper UTIs affect the proximal part of the ureters (pyelitis) or the proximal part of the ureters and the kidneys (pyelonephritis), and can cause renal scarring, abscess or failure, and sepsis. The most common signs and symptoms of lower UTIs are dysuria, increased urinary frequency and urgency, urine that is strong smelling, cloudy or contains blood, and persistent lower abdominal pain. Upper UTIs usually present with accompanying loin pain and fever. In pregnant women, asymptomatic bacteriuria is a risk factor for pyelonephritis and premature labour. UTIs in pregnancy have been associated with developmental delay and cerebral palsy in the infant, as well as fetal death. Insertion of a catheter into the urinary tract increases the risk of developing a UTI, and the longer the catheter is in place for, further increases the risk of bacteriuria. UTIs are considered recurrent after at least two episodes within 6 months, or three or more episodes within 12 months. Acute prostatitis is an infection of the prostate gland and is usually caused by a UTI. It can occur spontaneously or after certain medical procedures and can last for several weeks. Common symptoms include sudden onset of fever, acute urinary retention or irritative voiding symptoms. Possible complications include prostatic abscess, bacteraemia, epididymitis, and pyelonephritis. Chronic prostatitis is a complication of acute prostatitis and is deﬁned as at least 3 months of urogenital pain usually associated with lower urinary tract symptoms. Aims of treatment The aims of treatment are to relieve symptoms, treat the underlying infection, prevent systemic infection, and to reduce the risk of complications. Non-drug treatment g Patients with a UTI should be advised to drink plenty of ﬂuids to avoid dehydration, and to use self-care strategies to reduce the risk of recurrent infections. These include wiping from front to back after defaecation, not delaying urination, and not wearing occlusive underwear. D-mannose, cranberry or urine alkalinising products may be used as self-care treatment strategies, however the beneﬁt of these products for the prevention and treatment of UTIs has not been established. Patients should be advised to consider the sugar content of these products. h Drug treatment g When prescribing antibacterial therapy the severity of symptoms, risk of developing complications, previous urine culture and susceptibility results, and previous antibacterial use should be taken into consideration. With the exception of pregnant women, asymptomatic bacteriuria is not routinely treated with antibacterials. h For other considerations such as for patients receiving prophylactic antibacterial therapy, switching from intravenous to oral antibacterials, and for advice to give to patients, see Antibacterials, principles of therapy p. 527. g Reassess patients if symptoms worsen at any time, or do not start to improve within 48 hours of starting treatment. Refer patients to hospital if they have any symptoms or signs suggestive of a more serious illness or condition. Review choice of antibacterial when microbiological results are available, and change treatment as appropriate if susceptibility results indicate bacterial resistance. Advise patients that paracetamol or ibuprofen can be used for pain relief. Where appropriate codeine may be used in patients with acute pyelonephritis or prostatitis. h Lower urinary-tract infection Non-pregnant women g Consider a back-up antibacterial prescription for use if symptoms worsen or do not improve within 48 hours or an immediate antibacterial prescription. h Choice of antibacterial therapy . Oral ﬁrst line : ▶g Nitrofurantoin p. 625, or trimethoprim p. 607 (if low risk of resistance). h . Oral second line (if no improvement after at least 48 hours, or ﬁrst line not suitable): ▶g Nitrofurantoin (if not used ﬁrst line), fosfomycin p. 603, or pivmecillinam hydrochloride p. 585. h Men g An immediate antibacterial prescription should be given and a midstream urine sample obtained before treatment is taken and sent for culture and susceptibility testing. h Choice of antibacterial therapy . Oral ﬁrst line : ▶g Nitrofurantoin, or trimethoprim. h . Oral second line (if no improvement after at least 48 hours, or ﬁrst line not suitable): ▶Consider pyelonephritis or prostatitis. See pyelonephritis, acute, or prostatitis, acute below for guidance. Pregnant women g An immediate antibacterial prescription should be given and a midstream urine sample obtained before treatment is taken and sent for culture and susceptibility testing. h Choice of antibacterial therapy . Oral ﬁrst line : ▶g Nitrofurantoin. h . Oral second line (if no improvement after at least 48 hours, or ﬁrst line not suitable): ▶g Amoxicillin p. 579 (only if culture susceptible), or cefalexin p. 551. h . Alternative second line : ▶g Consult local microbiologist. h . Asymptomatic bacteriuria: ▶g Amoxicillin, cefalexin, or nitrofurantoin. h Prostatitis, acute g An immediate antibacterial prescription should be given and a midstream urine sample obtained before treatment is taken and sent for culture and susceptibility Infection testing. Refer patients to hospital if symptoms are not improving after 48 hours of treatment, or if they have any signs or symptoms suggestive of a more serious condition such as sepsis, acute urinary retention, or prostatic abscess. h Choice of antibacterial therapy . Oral ﬁrst line : ▶g Ciproﬂoxacin p. 590, or oﬂoxacin p. 593. ▶Alternative ﬁrst line (if unable to take ﬂuoroquinolones): trimethoprim. h . Oral second line (on specialist advice): ▶g Levoﬂoxacin p. 592, or co-trimoxazole p. 594. h . Intravenous ﬁrst line (if severely unwell or unable to take oral treatment). g Antibacterials may be combined if concerned about sepsis. ▶Amikacin p. 544, ceftriaxone p. 556, cefuroxime p. 553, ciproﬂoxacin, gentamicin p. 545, or levoﬂoxacin. h . Intravenous second line : ▶g Consult local microbiologist. h Pyelonephritis, acute g An immediate antibacterial prescription should be given and a midstream urine sample obtained before treatment is taken and sent for culture and susceptibility testing. Consider referring or seeking specialist advice for patients with acute pyelonephritis who are signiﬁcantly dehydrated or are unable to take oral ﬂuids and medicines, are pregnant, or have a higher risk of developing complications. h Non-pregnant women and men Choice of antibacterial therapy . Oral ﬁrst line : ▶g Cefalexin p. 551, or ciproﬂoxacin p. 590. If sensitivity known: co-amoxiclav p. 582, or trimethoprim p. 607. h . Intravenous ﬁrst line (if severely unwell or unable to take oral treatment). g Antibacterials may be combined if concerned about susceptibility or sepsis. ▶Amikacin p. 544, ceftriaxone p. 556, cefuroxime p. 553, ciproﬂoxacin, or gentamicin p. 545. Co-amoxiclav may be used if given in combination or sensitivity known. h . Intravenous second line : ▶g Consult local microbiologist. h Pregnant women Choice of antibacterial therapy . Oral ﬁrst line : ▶g Cefalexin. h . Intravenous ﬁrst line (if severely unwell or unable to take oral treatment): ▶g Cefuroxime. h . Second line or combining antibacterials if concerned about susceptibility or sepsis: ▶g Consult local microbiologist. h Recurrent urinary-tract infection g For patients with recurrent UTIs, refer or seek specialist advice for men, pregnant women, patients with suspected cancer, those presenting with recurrent upper UTI, and those with recurrent lower UTI with an unknown cause. For postmenopausal women experiencing recurrent UTIs, consider a vaginal oestrogen [unlicensed indication] at the lowest effective dose if behavioural and personal hygiene measures alone are not effective or appropriate. Treatment should be reviewed within 12 months. Oral oestrogens (hormone replacement therapy) should not be given to postmenopausal women speciﬁcally to reduce the risk of recurrent UTIs. In non-pregnant women, consider a trial of antibacterial prophylaxis if behavioural and personal hygiene measures, and vaginal oestrogen (in postmenopausal women) are not effective or appropriate. Single-dose antibacterial Infection prophylaxis [unlicensed indication] should be considered for use when exposed to an identiﬁable trigger. Daily antibacterial prophylaxis should be considered in non- pregnant women who have had no improvement after single-dose antibacterial prophylaxis, or who have no identiﬁable triggers. With specialist advice, daily antibacterial prophylaxis should be considered for men and pregnant women if behavioural and personal hygiene measures alone are not effective or appropriate. Advise patients about the risk of resistance with long-term antibacterial use, seeking medical help if symptoms of an acute UTI develop, and to return for review within 6 months. Review the success and ongoing need of prophylaxis at least every 6 months. If antibacterial prophylaxis is stopped ensure the patient has rapid access to treatment if they develop an acute UTI. h Women and men Choice of antibacterial therapy . Oral ﬁrst line : ▶g Trimethoprim, or nitrofurantoin p. 625. h . Oral second line : ▶g Amoxicillin p. 579 [unlicensed indication], or cefalexin. h Catheter-associated urinary-tract infection g For people with a catheter-associated urinary-tract infection, consider removing or changing the catheter as soon as possible if it has been in place for longer than 7 days, without delaying antibacterial treatment. An immediate antibacterial prescription should be given and a urine sample obtained before treatment is taken and sent for culture and susceptibility testing. Consider referring or seeking specialist advice for patients with a catheter-associated UTI who are signiﬁcantly dehydrated or unable to take oral ﬂuids and medicines, are pregnant, have a higher risk of developing complications, have recurrent catheter-associated UTIs, or have bacteria resistant to oral antibacterials. h Non-pregnant women and men Choice of antibacterial therapy . Oral ﬁrst line (if no upper UTI symptoms): ▶g Amoxicillin (only if culture susceptible), nitrofurantoin, or trimethoprim (if low risk of resistance). h . Oral second line (if no upper UTI symptoms and ﬁrst-line not suitable): ▶g Pivmecillinam hydrochloride p. 585. h . Oral ﬁrst line (upper UTI symptoms): ▶g Cefalexin, ciproﬂoxacin, co-amoxiclav (if culture susceptible), or trimethoprim (if culture susceptible). h . Intravenous ﬁrst line (if severely unwell or unable to take oral treatment). g Antibacterials may be combined if concerned about susceptibility or sepsis. ▶Amikacin, ceftriaxone, cefuroxime, ciproﬂoxacin, gentamicin, or co-amoxiclav (only in combination, unless culture results conﬁrm susceptibility). h . Intravenous second line : ▶g Consult local microbiologist. h Pregnant women Choice of antibacterial therapy . Oral ﬁrst line : ▶g Cefalexin. h . Intravenous ﬁrst line (if severely unwell or unable to take oral treatment): ▶g Cefuroxime. h . Second line or combining if concerned about susceptibility or sepsis: ▶g Consult local microbiologist. h Useful Resources Urinary tract infection (lower): antimicrobial prescribing. National Institute for Health and Care Excellence. Clinical Guideline 109. October 2018. www.nice.org.uk/guidance/ng109 Prostatitis (acute): antimicrobial prescribing. National Institute for Health and Care Excellence. Clinical Guideline 110. October 2018. www.nice.org.uk/guidance/ng110 Pyelonephritis (acute): antimicrobial prescribing. National Institute for Health and Care Excellence. Clinical Guideline 111. October 2018. www.nice.org.uk/guidance/ng111 Urinary tract infection (recurrent): antimicrobial prescribing. National Institute for Health and Care Excellence. Clinical Guideline 112. October 2018. www.nice.org.uk/guidance/ng112 Urinary tract infection (catheter-associated): antimicrobial prescribing. National Institute for Health and Care Excellence. Clinical Guideline 113. November 2018. www.nice.org.uk/guidance/ng113 Patient decision aids: Urinary tract infection (lower); Urinary tract infection (recurrent) National Institute for Health and Care Excellence. November 2018. www.nice.org.uk/about/what-we-do/our-programmes/nice- guidance/nice-guidelines/shared-decision-making ANTIBACTERIALS › OTHER

Source pages 644, 645, 646

Clinical care

Extracted information for Pyrazinamide only.

Patient And Carer Advice

Hepatic disorders Patients or their carers should be told how to recognise signs of liver disorder, and advised to discontinue treatment and seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop. Medicines for Children leaflet: Pyrazinamide for treatment of tuberculosis www.medicinesforchildren.org.uk/pyrazinamide- treatment-tuberculosis

Source page 644

Dose text by age group

Filter the extracted dose blocks for this individual drug.

Children

First line only; read the complete Indications and dose section above.

35 mg/kg once daily for

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 643

Children

First line only; read the complete Indications and dose section above.

35 mg/kg once daily

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 643

Children

First line only; read the complete Indications and dose section above.

50 mg/kg 3 times a week

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 644

Children

First line only; read the complete Indications and dose section above.

50 mg/kg 3 times a

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 644

Age labels are extracted from the printed dose headings and require clinical review. Confirm current local guidance, dose, route, formulation, contraindications and interactions before prescribing.

Individual generic drug information

pyrazinamide

Reference monograph

Part of registered formulation

PYRAZINAMIDE

Reference record: Pyrazinamide
Source: BNF 80 (2020–2021)
Printed source pages: 643, 644, 645, 646
Age groups indexed: 2

Individual active ingredientSource records are displayed separately

Some source sections could not be separated reliably in the extraction. Review the printed source pages when a field is missing or incomplete.

Overview

Extracted information for Pyrazinamide only.

Indications And Dose

Source pages 643, 644

Contra Indications

Acute attack of gout (in adults)

Source page 644

Cautions

Diabetes. gout (in adults)

Source page 644

Prescribing And Dispensing Information

Source page 644

Safety

Extracted information for Pyrazinamide only.

Interactions

→Appendix 1: pyrazinamide

Source page 644

Side Effects

Source page 644

Pregnancy

Manufacturer advises use only if potential beneﬁt outweighs risk.

Source page 644

Breast Feeding

Amount too small to be harmful.

Source page 644

Hepatic Impairment

Manufacturer advises avoid in severe impairment, acute hepatic disease and for up to 6 months after occurrence of hepatitis (risk of increased exposure).

Source page 644

Renal Impairment

Source page 644

Monitoring Requirements

Source page 644

Dose and formulations

Extracted information for Pyrazinamide only.

Medicinal Forms

Source pages 644, 645, 646

Clinical care

Extracted information for Pyrazinamide only.

Patient And Carer Advice

Source page 644

Dose text by age group

Filter the extracted dose blocks for this individual drug.

Children

First line only; read the complete Indications and dose section above.

35 mg/kg once daily for

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 643

Children

First line only; read the complete Indications and dose section above.

35 mg/kg once daily

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 643

Children

First line only; read the complete Indications and dose section above.

50 mg/kg 3 times a week

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 644

Children

First line only; read the complete Indications and dose section above.

50 mg/kg 3 times a

This is a first-line fragment. Read the full Indications and Dose section above.

Candidate age grouping · source page 644

Age labels are extracted from the printed dose headings and require clinical review. Confirm current local guidance, dose, route, formulation, contraindications and interactions before prescribing.