Evaluation of the efficacy of N-Acetylcysteine combined with standard quadruple therapy versus standard quadruple therapy alone for Helicobacter pylori eradication

N-acetyl cysteine (NAC) has recently been proposed as an adjunctive therapy for the eradication of Helicobacter pylori infection due to its mucolytic, antioxidant, and antimicrobial properties. This study aimed to evaluate the efficacy of adding NAC to the standard 4-drug regimen consisting of amoxicillin, clarithromycin, pantoprazole, and bismuth subcitrate. In this double-blind, randomized clinical trial, 92 patients with confirmed H. pylori infection were randomly assigned to either the intervention group or the control group (46 patients each) using a randomized block design. All patients received a 14-day course of amoxicillin, clarithromycin, pantoprazole, and bismuth subcitrate. The intervention group also received NAC tablets, while the control group received a placebo, matched in dose and schedule. Eradication of H. pylori was assessed two weeks after treatment cessation using the urea breath test. H. pylori eradication was achieved in 78.3% of patients in the intervention group (95% CI: 66.38–90.21) and 71.7% in the placebo group (95% CI: 59.57–84.49), with no statistically significant difference between groups (p=0.804). The overall eradication rate among all participants was 75% (95% CI: 64.72–85.77). Of the 23 patients who failed treatment, 14 were smokers, and smoking was significantly associated with treatment failure (p<0.0001). Notably, eradication rates among smokers were significantly higher in the NAC group compared to the placebo group (p=0.041). The addition of NAC to standard quadruple therapy did not significantly improve H. pylori eradication overall, but its potential benefit in specific subgroups such as smokers suggests the need for further research.