Really. INH is a 9-month long antibiotic.
I suppose it's time to really get my elbows flailing as I dig into what INH is all about. I mean, I know the basics, like it eliminates LTBI and is used in conjunction with other drugs to treat active TB. I know that it can cause liver toxicity and damage. But what does it really do?
The funny part is, I don't think the medical professionals REALLY know. They know that it works to inhibit mycolic reproduction and it's worked marvelously like that since the 1950's when they first started using it.
But how does it really do that?
Background: Isoniazid (Laniazid, Nydrazid), also known as isonicotinylhydrazine (INH), is an organic compound that is the first-line antituberculosis medication in prevention and treatment. It was first discovered in 1912, and later in 1951 it was found to be effective against tuberculosis. Isoniazid is never used on its own to treat active tuberculosis because resistance quickly develops. Isoniazid is available in tablet, syrup, and injectable forms (given intramuscularly or intravenously). Isoniazid is available worldwide, is inexpensive and is generally well tolerated. It is manufactured from isonicotinic acid (Wikipedia)
The Process: Isoniazid is a prodrug and must be activated by a bacterial catalase-peroxidase enzyme called KatG.[5] KatG couples the isonicotinic acyl with NADH to form isonicotinic acyl-NADH complex. This complex binds tightly to ketoenoylreductase known as InhA, thereby blocking the natural enoyl-AcpM substrate and the action of fatty acid synthase. This process inhibits the synthesis of mycolic acid, required for the mycobacterial cell wall. A range of radicals are produced by KatG activation of Isoniazid, including nitric oxide[6] which has also been shown to be important in the action of another antimycobacterial prodrug PA-824.[7]
Alright - I can tell I'm going to have to work more on this - very convoluted!
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