A systematic review and meta-analysis of the efficacy and safety of N-acetylcysteine in preventing aminoglycoside-induced ototoxicity: implications for the treatment of multidrug-resistant TB

What this study found

NAC coadministration was associated with an otoprotective effect in the prevention studies. In pooled analysis of 3 studies with 146 participants, the relative risk for ototoxicity at 4 to 6 weeks was 0.14 (95% CI 0.05 to 0.45) and the risk difference was -33.3% (95% CI -45.5% to -21.2%). Longer-term NAC use also appeared generally safe across heterogeneous conditions, although gastrointestinal adverse events were more common with NAC than with placebo. Overall, the findings support further clinical testing of NAC with aminoglycosides, including in MDR-TB settings.

Study & population

This was a systematic review and meta-analysis of NAC coadministration with aminoglycosides for ototoxicity prevention, with prevention data drawn from patients on dialysis treated with gentamicin or amikacin.

Intervention

N-acetylcysteine (NAC) was given as 600 mg twice daily alongside aminoglycoside therapy in the prevention studies.

Key limitation

The prevention evidence was based on only 3 small studies, and the overall dataset was limited to 146 participants.

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