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Article
March 22, 1995

Drug-Resistant Tuberculosis: Inconsistent Results of Pyrazinamide Susceptibility Testing-Reply

Author Affiliations

New York State Department of Health Albany

JAMA. 1995;273(12):917. doi:10.1001/jama.1995.03520360030023
Abstract

In Reply.  —Pyrazinamide is one of the most important drugs in modern chemotherapy of tuberculosis; its inclusion in treatment regimens has made possible the shortening of therapy to 6 months. The recent increase in tuberculosis with several nosocomial outbreaks of multidrug-resistant strains has challenged the public health system. New recommendations by the CDC and the American Thoracic Society1,2 require in vitro drug susceptibility testing of M tuberculosis isolates for all five first-line drugs (pyrazinamide included) from all patients and reporting of these results to the local health department.Unfortunately, testing the susceptibility of tubercle bacilli to pyrazinamide is problematic since pyrazinamide is active only at an acid pH. After a series of reports regarding susceptibility testing (available from the author on request), 100 μg of pyrazinamide per milliliter at pH 6.0 is now the recommended test concentration.3The results of Dr Hewlett and coworkers are so unexpectedly divergent

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