Isoniazid Preventive Therapy in Tuberculosis Management

Isoniazid Preventive Therapy (IPT) has become a cornerstone of global tuberculosis control by interrupting the progression from latent Mycobacterium tuberculosis infection to active disease. Administered as a daily or intermittent regimen over six to twelve months, isoniazid targets dormant bacilli in individuals with immunological evidence of infection but no symptoms. Its principal indications include household contacts of smear-positive cases, people living with HIV, and young children in high-burden settings. Over recent decades, IPT has been incorporated into national guidelines and scaled up alongside antiretroviral therapy and active case finding. Despite clear efficacy in reducing the risk of active tuberculosis by up to 60 per cent in children and similar benefits in adults, implementation challenges persist: underdiagnosis of latent infection, concerns over hepatic toxicity, supply interruptions, and fears of selecting drug-resistant strains. Economic evaluations have demonstrated that well-resourced IPT programmes yield favourable cost-effectiveness ratios, particularly where incidence is high. Integration of IPT with systematic contact screening and adherence support has emerged as a practical model to maximise population impact and to move towards tuberculosis elimination goals.

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Isoniazid Preventive Therapy in Tuberculosis Management publication trend

The graph below shows the total number of articles in isoniazid preventive therapy in tuberculosis management across all publications each year (not limited to Nature Index journals).

Technical terms

Isoniazid Preventive Therapy (IPT): A regimen of isoniazid administered to individuals with latent tuberculosis infection to prevent progression to active disease.

Latent Tuberculosis Infection (LTBI): A state in which a person harbours Mycobacterium tuberculosis organisms without clinical or radiographic evidence of active disease but may react to immunodiagnostic tests.

Contact Screening: Systematic identification and evaluation of individuals who have shared living spaces or close environments with a person diagnosed with active tuberculosis.

Disability-Adjusted Life Year (DALY): A measure combining years of life lost to premature mortality and years lived with disability, used to quantify the burden of disease and the impact of interventions.

Tuberculin Skin Test (TST): A diagnostic tool in which purified protein derivative of tuberculin is injected intradermally to elicit a delayed hypersensitivity reaction in individuals sensitised to Mycobacterium tuberculosis antigens.

References

1. Cost-effectiveness analysis of interventions to improve diagnosis and preventive therapy for paediatric tuberculosis in 9 sub-Saharan African countries: A modelling study. PLOS Medicine (2023).
2. Public Health Impact and Cost-Effectiveness of Screening for Active Tuberculosis Disease or Infection Among Children in South Africa. Clinical Infectious Diseases (2023).
3. Efficacy of isoniazid prophylactic therapy in prevention of tuberculosis in children: a meta–analysis. BMC Infectious Diseases (2014).
4. Isoniazid Prophylactic Therapy for the Prevention of Tuberculosis in HIV Infected Adults: A Systematic Review and Meta-Analysis of Randomized Trials. PLOS ONE (2015).
5. Isoniazid Preventive Therapy and Risk for Resistant Tuberculosis - Volume 12, Number 5—May 2006 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2006).
6. Uptake of Isoniazid Preventive Therapy among Under-Five Children: TB Contact Investigation as an Entry Point. PLOS ONE (2016).