N-acetylcysteine effective in reducing antimicrobials induced nephrotoxicity: Study

A new study published in the journal of BMC Nephrology showed that N-acetylcysteine (NAC) has been linked to a reduction in nephrotoxicity brought on by antibiotics.

In clinical practice, antimicrobials are frequently used to treat a variety of infectious disorders. According to the recommendations, patient survival can be increased by 7.6% with timely diagnosis (within an hour) and timely administration of effective antimicrobials. However, there is a chance that using antimicrobials might have negative side effects, such as nephrotoxicity. And, nephrotoxicity brought on by antibiotics may cause acute kidney damage (AKI), extended hospital stays, and increased medical expenses.

Numerous antibiotic classes have been shown to have the capacity to cause nephrotoxicity. These consist of beta-lactams, vancomycin, fluoroquinolones, and aminoglycosides. A commonly recommended antioxidant, N-acetylcysteine (NAC) has shown positive renoprotective effects in a number of studies.

In both clinical and experimental animal models, NAC has been shown to reduce inflammation and oxidative stress, enhance kidney function, and guard against nephrotoxic damage. The lack of randomized clinical studies makes it difficult to assess NAC's effectiveness in patients receiving antibiotics, even if it may lower the frequency of AKI in patients undergoing heart surgery and contrast delivery. This study evaluated effectiveness of NAC in avoiding nephrotoxicity caused by antibiotics.

Up to June 1, 2024, a thorough search of Pubmed, Web of Science, Embase, and the Cochrane Library was conducted to find pertinent research assessing the effects of NAC on antibiotic-induced nephrotoxicity. The inclusion and exclusion criteria were used to filter eligible records. To assess how NAC affected nephrotoxicity, the odds ratio (OR) was chosen. This study used a random effects model to pool the retrieved data.

This analysis comprised 3 randomized controlled trials. The combined findings demonstrated that NAC might lower the frequency of nephrotoxicity brought on by antibiotics. On Day 2, the NAC group's serum creatine (Scr) was much lower than that of the placebo group. Blood urea nitrogen (BUN) and creatinine clearance (CrCl) did not differ.

Overall, the outcomes of this study found NAC to reduce nephrotoxicity associated with antibiotics. Large-scale RCTs are imperative for more study in order to validate these encouraging results.

Source:

Qiu, X., Yang, S., Zhang, Y., Wang, Q., Kong, L., & Zhou, L. (2025). Effect of N-acetylcysteine on antimicrobials induced nephrotoxicity: a meta-analysis. BMC Nephrology, 26(1), 128. https://doi.org/10.1186/s12882-025-04037-y