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N-acetylcysteine in children: current data and novel opportunities

https://doi.org/10.18093/0869-0189-2017-27-6-811-815

Abstract

The optimal choice of effective and safe mucolytic drug is an important issue, especially in pediatric practice. A role of N-acetylcysteine (NAC) for treatment of upper and lower respiratory infections in children has been discussed in this review. Randomised controlled trials confirmed significant mucolytic effect and safety of NAC in children > 2 years old without excessive increase in bronchorrhea. Compared to other mucolytics NAC has additional therapeutic properties such as antioxidant and antitoxic (particularly, in paracetamol poisoning). NAC could destroy bacterial biofilms and prevent their occurrence. Original NAC (Fluimucil®) is available in different drug formulations: granules and tablets for oral solution, solution for inhalation and parenteral use. Since 2016, Fluimucil has been available as oral solution for children ≥ 2 years old with ease dosing.

About the Authors

I. A. Dronov
I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia
Russian Federation

Ivan A. Dronov, Candidate of Medicine, Associate Professor, Department of Pediatric Diseases, Therapeutic Faculty, clinical pharmacologist, University Pediatric Teaching Hospital 

Trubetskaya ul. 8, build. 2, Moscow, 119991, Russia



M. D. Shakhnazarova
I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia
Russian Federation

Marina D. Shakhnazarova, Candidate of Medicine, Associate Professor, Department of Pediatric Diseases, Therapeutic Faculty 

Trubetskaya ul. 8, build. 2, Moscow, 119991, Russia



References

1. Suddarth S.B. Acetylcysteine, a new and effective mucolytic agent. Bull. Geisinger. 1963; 15: 65–69.

2. Geppe N.A., Malakhov A.B. Mucolytic and antitussive agents in pediatric practice (a lection). Detskiy doktor. 1999; (4): 42–45 (in Russian).

3. Morozova T.E., Andrushchishina T.B. Acetylcysteine in clinical practice. Vrach. 2007; (12): 37–38 (in Russian).

4. Chalumeau M., Duijvestijn Y.C. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochrane Database Syst. Rev. 2013; (5): CD003124. DOI: 10.1002/14651858.CD003124.pub4.

5. US National Library of Medicine National Institutes of Health. Available at: www.ncbi.nlm.nih.gov/pubmed/ [Accessed 19.11.2017] (внутритекстовая ссылка!)

6. Chikina S.Yu., Chuchalin A.G. N-acetylcysteine: do we use all opportunities? Atmosfera. Pul'monologiya i allergologiya. 2013; (1): 20–26 (in Russian).

7. Aruoma O.I., Halliwell B., Hoey B.M., Butler J. The antioxidant action of N-acetylcysteine: its reaction with hydrogen peroxide, hydroxyl radical, superoxide, and hypochlorous acid. Free Radic. Biol. Med. 1989; 6 (6): 593–597. DOI: 10.1016/0891-5849(89)90066-X.

8. Barnes P.J. Chronic obstructive pulmonary disease. N. Engl. J. Med. 2000; 343 (4): 269–280. DOI: 10.1056/NEJM200007273430407

9. Yoon E., Babar A., Choudhary M. et al. Acetaminophen-induced hepatotoxicity: a comprehensive update. J. Clin. Transl. Hepatol. 2016; 4 (2): 131–142. DOI: 10.14218/JCTH.2015.00052.

10. Sav'yuk F., Danel' V., Zobnin Yu.V. Acute paracetamol poisoning: a rescue treatment. Sibirskiy meditsinskiy zhurnal. 2008; (6): 107–111 (in Russian).

11. Jaeschke H. Acetaminophen: dose-dependent drug hepatotoxicity and acute liver failure in patients. Dig. Dis. 2015; 33 (4): 464–471. DOI: 10.1159/000374090.

12. American Academy of Pediatrics. Committee on Drugs. Acetaminophen toxicity in children. Pediatrics. 2001; 108 (4): 1020–1024. DOI: 10.1542/peds.108.4.1020.

13. Heard K.J. Acetylcysteine for acetaminophen poisoning. N. Engl. J. Med. 2008; 359 (3): 285–292. DOI: 10.1056/NEJMct0708278.

14. Smilkstein M.J., Knapp G.L., Kulig K.W., Rumack B.H. Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985). N. Engl. J. Med. 1988; 319 (24): 1557–1562. DOI: 10.1056/NEJM198812153192401.

15. Brok J., Buckley N., Gluud C. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database Syst. Rev. 2006; (2): CD003328. DOI: 10.1002/14651858.CD003328.pub2.

16. Mehrpour O., Ballali-Mood M. Why not formulate an acetaminophen tablet containing N-acetylcysteine to prevent poisoning? J. Med. Toxicol. 2011; 7 (1): 95–96. DOI: 10.1007/s13181-010-0126-2.

17. El-Ebiary A.A., Elsharkawy R.E., Soliman N.A. et al. N-acetylcysteine in acute organophosphorus pesticide poisoning: a randomized, clinical trial. Basic. Clin. Pharmacol. Toxicol. 2016; 119 (2): 222–227. DOI: 10.1111/bcpt.12554.

18. Tehrani H., Halvaie Z., Shadnia S. et al. Protective effects of N-acetylcysteine on aluminum phosphide-induced oxidative stress in acute human poisoning. Clin. Toxicol. (Phila.). 2013; 51 (1): 23–28. DOI: 10.3109/15563650.2012.743029.

19. Montanini S., Sinardi D., Praticò C. et al. Use of acetylcysteine as the life-saving antidote in Amanita phalloides (death cap) poisoning. Case report on 11 patients. Arzneimittelforschung. 1999; 49 (12): 1044–1047.

20. Kasperczyk S., Dobrakowski M., Kasperczyk A. et al. Effect of N-acetylcysteine administration on homocysteine level, oxidative damage to proteins, and levels of iron (Fe) and Fe-related proteins in lead-exposed workers. Toxicol. Ind. Health. 2016; 32 (9): 1607–1618. DOI: 10.1177/0748233715571152.

21. Baniasadi S., Eftekhari P., Tabarsi P. et al. Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity. Eur. J. Gastroenterol. Hepatol. 2010; 22 (10): 1235–1238. DOI: 10.1097/MEG.0b013e32833aa11b.

22. Karimzadeh I., Khalili H., Sagheb M.M., Farsaei S. A double-blinded, placebo-controlled, multicenter clinical trial of N-acetylcysteine for preventing amphotericin B-induced nephrotoxicity. Expert Opin. Drug Metab. Toxicol. 2015; 11 (9): 1345–1355. DOI: 10.1517/17425255.2015.1042363.

23. Kocyigit I., Vural A., Unal A. et al. Preventing amikacin related ototoxicity with N-acetylcysteine in patients undergoing peritoneal dialysis. Eur. Arch. Otorhinolaryngol. 2015; 272 (10): 2611–2620. DOI: 10.1007/s00405-014-3207-z.

24. Feldman L., Efrati S., Eviatar E. et al. Gentamicin-induced ototoxicity in hemodialysis patients is ameliorated by N-acetylcysteine. Kidney Int. 2007; 72 (3): 359–363. DOI: 10.1038/sj.ki.5002295.

25. Blasi F., Page C., Rossolini G.M. et al. The effect of N-acetylcysteine on biofilms: Implications for the treatment of respiratory tract infections. Respir. Med. 2016; 117: 190–197. DOI: 10.1016/j.rmed.2016.06.015.

26. Domenech M., García E. N-acetyl-cysteine and cysteamine as new strategies against mixed biofilms of nonencapsulated Streptococcus pneumoniae and nontypeable Haemophilus influenza. Antimicrob. Agents Chemother. 2017; 61 (2): e01992-16. DOI: 10.1128/AAC.01992-16.

27. Dinicola S., De Grazia S., Carlomagno G., Pintucci J.P. N-acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review. Eur. Rev. Med. Pharmacol. Sci. 2014; 18 (19): 2942–2948.

28. Leite B, Gomes F, Teixeira P. et al. Staphylococcus epidermidis biofilms control by N-acetylcysteine and rifampicin. Am. J. Ther. 2013; 20 (4): 322–328. DOI: 10.1097/MJT.0b013e318209e17b.

29. Macchi A., Ardito F., Marchese A. et al. Efficacy of N-acetyl-cysteine in combination with thiamphenicol in sequential (intramuscular/aerosol) therapy of upper respiratory tract infections even when sustained by bacterial biofilms. J. Chemother. 2006; 18 (5): 507–513. DOI: 10.1179/joc.2006.18.5.507.

30. Babić I., Baudoin T., Trotić R., Bedeković V. Therapeutic efficacy of azithromycin and acetylcysteine in chronic otitis media with effusion. Eur. Arch. Otorhinolaryngol. 2017; 274 (3): 1351–1356. DOI: 10.1007/s00405-016-4389-3.


Review

For citations:


Dronov I.A., Shakhnazarova M.D. N-acetylcysteine in children: current data and novel opportunities. PULMONOLOGIYA. 2017;27(6):811-815. (In Russ.) https://doi.org/10.18093/0869-0189-2017-27-6-811-815

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ISSN 0869-0189 (Print)
ISSN 2541-9617 (Online)