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Arch Iran Med. 2025;28(5): 257-263.
doi: 10.34172/aim.33355
  Abstract View: 111
  PDF Download: 96

Original Article

Efficacy Of N-Acetyl-Cysteine as Adjuvant Therapy for Diabetic Foot Osteomyelitis: An Open-Label Randomized Controlled Trial

Laya Hooshmand Gharabagh 1 ORCID logo, Mehdi Heydaroghli 2 ORCID logo, Ayda Esmaeili 3,4* ORCID logo

1 Department of Internal Medicine, School of Medicine, Urmia University of Medical Sciences, Imam Khomeini Hospital, Urmia, Iran
2 Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
3 Department of Clinical Pharmacy, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
4 Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
*Corresponding Author: Ayda Esmaeili, Email: esmaeili.a@umsu.ac.ir, Email: ph.a.esmaeili@gmail.com

Abstract

Background: Biofilm formation by bacteria on the lower limb arises from reduced peripheral arterial blood flow, which can lead to the failure of antibiotic therapy or require longer duration of intravenous antibiotic therapy in diabetic foot infection-associated osteomyelitis. N-acetyl cysteine (NAC), an agent known to prevent and treat biofilm-related infections, was used as a novel strategies beside antibiotic therapy in osteomyelitis of diabetic foot with the aim of accelerating the response to antibiotic therapy regimen.

Methods: To assess the synergistic effect of NAC with antibiotic therapy, patients with diabetic foot osteomyelitis (DFO) (grade III or IV Wagner) were randomly assigned to either NAC 600 mg effervescent tablet twice daily for 2 weeks or the control group. Clinical and laboratory data, including white blood cell with differentiation and inflammatory factors (ESR and CRP) were measured at baseline (time 0), after one week and after three weeks of initiating the intervention.

Results: Fifty-three eligible patients completed the study. All evaluated infectious-related laboratory parameters showed significant reductions in the NAC group compared to control (P<0.05), except for lymphocyte proportion and NLR (P; 0.11 and 0.84, respectively). The drop rate of ESR and CRP were accelerated by NAC compared to the control group (-49.44±6.04 vs -7.17±3.99; -44.43±4.21 vs -14.02±4.05, respectively, P<0.05).

Conclusion: In order to accelerate antibiotic responses and the trend of reduction in infectious inflammatory markers during the therapy, oral NAC 600 mg twice daily may be considered in the treatment protocol of patients with DFO.



Cite this article as: Hooshmand Gharabagh L, Heydaroghli M, Esmaeili A. Efficacy of N-acetyl-cysteine as adjuvant therapy for diabetic foot osteomyelitis: an open-label randomized controlled trial. Arch Iran Med. 2025;28(5):257-263. doi: 10.34172/aim.33355
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Submitted: 25 Oct 2024
Revision: 07 Mar 2025
Accepted: 16 Mar 2025
ePublished: 01 May 2025
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