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Evidence summaries

N-Acetylcysteine as an Adjuvant Therapy for Helicobacter Pylori Eradication

There is insufficient evidence whether the addition of N-acetylcysteine (NAC) to antibiotics improves H pylori eradication rates compared with the addition of placebo or no NAC. Level of evidence: "D"

The quality of evidence is downgraded by study quality and imprecise results.

Summary

A Cochrane review [Abstract] 1 included 8 studies with a total of 559 subjects. Included were RCTs of any antibiotic regimen plus NAC, in adults infected with H pylori. To be included, trials had to use a control consisting of the same antibiotic regimen with or without placebo.

It is uncertain whether the addition of NAC to antibiotics improves H pylori eradication rates, compared with the addition of placebo or no NAC (38.8% versus 49.1%, RR 0.74, 95% CI 0.51 to 1.08; participants = 559; 8 studies). A post-hoc sensitivity analysis, in which were removed studies that tested antibiotic regimens no longer recommended in clinical practice, showed that the addition of NAC may improve eradication rates compared to control (27.2% versus 37.6%, RR 0.71, 95% CI 0.53 to 0.94; participants = 397; 5 studies).

It is uncertain whether NAC is associated with a higher risk of gastrointestinal adverse events compared to control (23.9% versus 18.9%, RR 1.25, 95% CI 0.85 to 1.85; participants = 336; 5 studies), or allergic adverse events (2% versus 0%, RR 2.98, 95% CI 0.32 to 27.74; participants = 336; 5 studies = five). There were no reports of toxic adverse events amongst included studies.

Links

SOF Table http://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012357.pub2/full#CD012357-sec1-0001

Abstract in McMaster database

Clinical comments

Note

Date of latest search:

    References

    • Fontes LES, Martimbianco ALC, Zanin C et al. N-acetylcysteine as an adjuvant therapy for Helicobacter pylori eradication. Cochrane Database Syst Rev 2019;(2):CD012357. [PubMed]

Primary/Secondary Keywords