Year: 2026
Type: review
Abstract: Isoniazid (INH) remains a cornerstone of tuberculosis (TB) treatment; however, its early bactericidal activity (EBA) and associated adverse effects vary substantially among individuals. Although personalized dosing has been proposed, its clinical implementation remains limited, largely due to incomplete characterization of the predictive factors. This review synthesizes evidence from PubMed-indexed EBA studies of INH to identify key determinants of its variable efficacy and to guide individualized dose selection across different clinical settings. We found that individual N-acetyltransferase 2 (NAT2) acetylator status is a critical predictor of both the EBA of INH and the risk of drug–induced liver injury (DILI). Geographic variation in NAT2 acetylator phenotypes likely explains a substantial proportion of the regional disparities in reported EBA. Additionally, escalating the INH dosage may overcome low–level resistance associated with inhA promoter mutations. In conclusion, personalizing INH dosage based on NAT2 acetylator type—especially for rapid acetylators—and increasing doses to address inhA –mediated resistance may improve therapeutic efficacy and safety. Integrating these host and pathogen factors into clinical practice could help optimize TB treatment outcomes across diverse populations and resistance profiles.
Source: Biosafety and Health
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,500
OpenAlex ID: W7167621649