N-acetyl cysteine as an adjunct to standard anti-Helicobacter pylori eradication regimen in patients with dyspepsia: A prospective randomized, open-label trial

Authors
Mohammad Hassan Emami 1
Mehdi Zobeiri 2
Hojatolah Rahimi 3
Fariba Arjomandi 4
Hamed Daghagzadeh 5
Peyman Adibi 1
Jalal Hashemi 6
1 Departments of Gastroenterology and Liver Disease, Kermanshah University of Medical Sciences, Iran
2 Kermanshah University of Medical Sciences, Iran
3 Poursina Hakim Research Institute Isfahan, Iran
4 Department of Community Medicine, Islamic Azad University, Najafabad Branch, Iran
5 Department of Internal Medicine, Isfahan University of Medical Sciences, Iran
6 Department of Gastroenterology and Liver Disease, Ahvaz University of Medical Sciences, Iran
Abstract
Background: Increasing antibiotic resistance of Helicobacter pylori (H. pylori) which is associated with diseases of the upper gastrointestinal tract, has made alternative treatments necessary. This study compares the efficacy of adding N-acetyl cysteine (NAC) to standard regimen for H. pylori eradication.
Materials and Methods: We conducted a randomized, open-label trial, comparing the efficacy of 14 days of quadruple therapy with Amoxicillin, Bismuth citrate, Omeprazole, Clarithromycin (group A) versus 14 days of above regimen plus NAC (group B) in adult patients with dyspepsia. Primary objective was H. pylori eradication.Compliance and side effects were determined by questionnaires. Our analysis was by intention-to-treat (ITT) and per-protocol. This study is registered with www.IRCT.ir, number: IRCT201201078634N1.
Result: A total of 121 participants aged 21-76 years with a mean age of 44.5 ± 14.1, and 52.9% female, were randomly allocated a treatment: 60 with 14-day standard therapy and 61 with 14-day standard therapy with NAC. The eradication rate in groups A and B with ITT analyses was 49/60 (81.7%; 95% [confidence intervals] CI = 71.6-91.8%) and 50/61 (82%; 95% CI = 72-91.9%), respectively ( P = 0.96). In per-protocol analysis, the rate of H. pylori eradication in groups A and B was 45/54 (83.3%; 95% CI = 73.1-93.6%) and 45/53 (84.9%; 95% CI = 74.9-94.9%), respectively ( P = 0.82). Minor well tolerated side effects were reported in 15 (34.9%) and 21 (35.6%) patients of groups A and B, respectively, and only one therapy cessation in group A was created.
Conclusion: Standard 14-day triple-drug therapy with NAC is not preferable to standard drug regimens for H. pylori infection.
Keywords
Helicobacter pylori
Helicobacter pylori eradication
N-acetyl cysteine
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Advanced Biomedical Research
Volume 2014, september
September 2014
Pages 1-5