From the Guidelines
The maximum dosage of pyrazinamide in anti-tubercular treatment is 2000 mg per day for adults, while rifampicin's maximum daily dose is 600 mg for adults. For pyrazinamide, the recommended weight-based dosing is 20-30 mg/kg daily (maximum 2000 mg), and for rifampicin, it's 10 mg/kg daily (maximum 600 mg) 1. These medications are typically part of a multi-drug regimen for tuberculosis treatment, usually combined with isoniazid and ethambutol in the intensive phase. Pyrazinamide is generally used only during the first two months of treatment, while rifampicin continues throughout the entire treatment course (usually 6-9 months).
Key Considerations
- Dosage adjustments may be necessary for patients with renal or hepatic impairment.
- Both medications can cause hepatotoxicity, so liver function should be monitored regularly.
- Rifampicin may turn body fluids orange-red and interacts with many medications by inducing cytochrome P450 enzymes, potentially reducing the effectiveness of oral contraceptives, anticoagulants, and antiretrovirals, among others.
Dosing Recommendations
- Pyrazinamide: 20-30 mg/kg daily (maximum 2000 mg)
- Rifampicin: 10 mg/kg daily (maximum 600 mg) It's essential to follow the guidelines and consult with a healthcare professional for personalized treatment plans, as the treatment of tuberculosis requires careful consideration of various factors, including patient weight, renal function, and potential drug interactions 1.
From the FDA Drug Label
Pyrazinamide is administered orally, 15 to 30 mg/kg once daily Three grams per day should not be exceeded. The CDC recommendations do not exceed 2 g per day when given as a daily regimen
Drug Maximal Daily Dose in Children and Adults Isoniazid 300 mg Rifampin 600 mg Pyrazinamide 2 g Streptomycin 1 g** Ethambutol 2. 5 g
The maximum dosage of pyrazinamide is 2 g per day and the maximum dosage of rifampicin is 600 mg per day 2.
From the Research
Anti-Tubercular Treatment
The maximum dosage of pyrazinamide and rifampicin in anti-tubercular treatment is not explicitly stated in the provided studies. However, the studies provide information on the pharmacokinetics and efficacy of these drugs in adults and children.
Pyrazinamide Dosage
- The study 3 suggests that children can receive the same mg/kg body weight pyrazinamide dosage as adults, as the maximum concentration (C(max)) achieved in children and adults is similar.
- The study 4 uses a dosage of 150 mg of pyrazinamide per tablet, with 1-4 tablets administered daily to children depending on their weight.
- The study 5 uses a dosage of 400 mg of pyrazinamide per single dose in healthy Chinese male volunteers.
Rifampicin Dosage
- The study 4 uses a dosage of 75 mg of rifampicin per tablet, with 1-4 tablets administered daily to children depending on their weight.
- The study 5 uses a dosage of 150 mg of rifampicin per single dose in healthy Chinese male volunteers.
- The study 6 suggests that the dose per kilogram of body weight is associated with the concentrations of rifampicin, and that human immunodeficiency virus infection is associated with reduced rifampicin concentrations.
Combination Therapy
- The study 7 uses a combination of isoniazid, rifampin, pyrazinamide, and ethambutol for 6 months to treat isoniazid-resistant tuberculosis, with successful outcomes.
- The study 4 suggests that optimal dosing of all drugs cannot be achieved with the current fixed-dose combinations, and proposes a new formulation and revised weight bands.