{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:29:25Z","timestamp":1772252965258,"version":"3.50.1"},"reference-count":55,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001713","name":"European &amp; Developing Countries Clinical Trial Partnerships (EDCTP)","doi-asserted-by":"publisher","award":["TMA2016SF-1463"],"award-info":[{"award-number":["TMA2016SF-1463"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001713","name":"European &amp; Developing Countries Clinical Trial Partnerships (EDCTP)","doi-asserted-by":"publisher","award":["T32 AI007046"],"award-info":[{"award-number":["T32 AI007046"]}],"id":[{"id":"10.13039\/501100001713","id-type":"DOI","asserted-by":"publisher"}]},{"name":"U.S. National Institutes of Health","award":["TMA2016SF-1463"],"award-info":[{"award-number":["TMA2016SF-1463"]}]},{"name":"U.S. National Institutes of Health","award":["T32 AI007046"],"award-info":[{"award-number":["T32 AI007046"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Background: New drug classes and regimens have shortened the treatment duration for drug-resistant tuberculosis, but adverse events (AEs) and organ toxicity remain unacceptably common. N-acetylcysteine (NAC) has demonstrated potential in reducing kidney and liver toxicity in other clinical settings, but efficacy in drug-resistant tuberculosis treatment has not been rigorously evaluated. Method: A randomized controlled trial was conducted at Kibong\u2019oto Infectious Diseases Hospital in Tanzania to assess the efficacy of NAC in reducing AEs in patients undergoing rifampin-resistant pulmonary tuberculosis treatment. Participants received an all-oral standardized rifampin-resistant regimen alone, with NAC 900 mg daily, or NAC 900 mg twice daily for 6 months. AEs, severe AEs, and renal and liver toxicity were monitored monthly and classified according to the Risk, Injury, Failure, Loss, and End-stage kidney disease criteria and National Cancer Institute Common Terminology Criteria for Adverse Events. Incident ratios and Kaplan\u2013Meier curves were employed to compare group event occurrences. Results: A total of 66 patients (mean age 47 \u00b1 12 years; 80% male) were randomized into three groups of 22. One hundred and fifty-eight AEs were recorded: 52 (33%) in the standard treatment group, 55 (35%) in the NAC 900 mg daily group, and 51 (32%) in the NAC 900 mg twice-daily group (p &gt; 0.99). Severe AEs were observed in four patients in the standard group, two in the NAC 900 mg daily group, and three in the NAC 900 mg twice-daily group. Renal toxicity was more prevalent in the standard treatment group compared to those that received NAC (45% vs. 23%; p = 0.058), with a shorter onset of time to toxicity (\u03c72 = 3.199; p = 0.074). Liver injury events were rare across all groups. Conclusion: Among Tanzanian adults receiving rifampin-resistant tuberculosis treatment, NAC did not significantly reduce overall AEs but demonstrated important trends in reducing renal toxicity.<\/jats:p>","DOI":"10.3390\/pharmaceutics17040516","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T06:50:27Z","timestamp":1744699827000},"page":"516","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["N-Acetylcysteine to Reduce Kidney and Liver Injury Associated with Drug-Resistant Tuberculosis Treatment"],"prefix":"10.3390","volume":"17","author":[{"given":"Idu","family":"Meadows","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Happiness","family":"Mvungi","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Disease Hospital, Siha 25102, Tanzania"},{"name":"Kilimanjaro Christian Medical College, Moshi 25212, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kassim","family":"Salim","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Disease Hospital, Siha 25102, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Kaswaga","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Disease Hospital, Siha 25102, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Mbelele","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Disease Hospital, Siha 25102, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alphonce","family":"Liyoyo","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Disease Hospital, Siha 25102, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hadija","family":"Semvua","sequence":"additional","affiliation":[{"name":"Kilimanjaro Christian Medical College, Moshi 25212, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athumani","family":"Ngoma","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Disease Hospital, Siha 25102, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott K.","family":"Heysell","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stellah G.","family":"Mpagama","sequence":"additional","affiliation":[{"name":"Kibong\u2019oto Infectious Disease Hospital, Siha 25102, Tanzania"},{"name":"Kilimanjaro Christian Medical College, Moshi 25212, Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"ref_1","unstructured":"(2024, May 06). Global Tuberculosis Report. Available online: https:\/\/www.who.int\/teams\/global-tuberculosis-programme\/tb-reports\/global-tuberculosis-report-2023."},{"key":"ref_2","unstructured":"(2023, December 14). WHO Announces Updated Definitions of Extensively Drug-Resistant Tuberculosis. Available online: https:\/\/www.who.int\/news\/item\/27-01-2021-who-announces-updated-definitions-of-extensively-drug-resistant-tuberculosis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/bmb\/ldh047","article-title":"Multidrug-resistant tuberculosis (MDR-TB): Epidemiology, prevention and treatment","volume":"73\u201374","author":"Ormerod","year":"2005","journal-title":"Br. Med. Bull."},{"key":"ref_4","unstructured":"(2023, November 16). WHO Consolidated Guidelines on Tuberculosis: Module 4: Treatment\u2014Drug-Resistant Tuberculosis Treatment, 2022 Update. World Health Organization, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK588564\/."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"277","DOI":"10.12701\/yujm.2020.00626","article-title":"Diagnosis and treatment of multidrug-resistant tuberculosis","volume":"37","author":"Jang","year":"2020","journal-title":"Yeungnam Univ. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"20503121231171350","DOI":"10.1177\/20503121231171350","article-title":"Adverse drug reactions and associated factors in multidrug-resistant tuberculosis: A retrospective review of patient medical records at Mbarara Regional Referral Hospital, Uganda","volume":"11","author":"Kushemererwa","year":"2023","journal-title":"SAGE Open Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"481","DOI":"10.7861\/clinmedicine.16-5-481","article-title":"Adverse drug reactions","volume":"16","author":"Coleman","year":"2016","journal-title":"Clin. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1056\/NEJMoa1811867","article-title":"A Trial of a Shorter Regimen for Rifampin-Resistant Tuberculosis","volume":"380","author":"Nunn","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1056\/NEJMoa2119430","article-title":"Bedaquiline\u2013Pretomanid\u2013Linezolid Regimens for Drug-Resistant Tuberculosis","volume":"387","author":"Conradie","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"144","DOI":"10.4236\/jtr.2014.23018","article-title":"Prevalence and Risk Factors of Adverse Drug Reactions Associated Multidrug Resistant Tuberculosis Treatments in Selected Treatment Centers in Addis Ababa Ethiopia","volume":"2","author":"Bezu","year":"2014","journal-title":"J. Tuberc. Res."},{"key":"ref_11","unstructured":"(2023, November 15). TB Prevalence in Tanzania|National Tuberculosis & Leprosy Programme. Available online: https:\/\/ntlp.go.tz\/tuberculosis\/tb-prevalence-in-tanzania\/."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s40814-023-01281-7","article-title":"Protocol for a feasibility randomized controlled trial to evaluate the efficacy, safety and tolerability of N-acetylcysteine in reducing adverse drug reactions among adults treated for multidrug-resistant tuberculosis in Tanzania","volume":"9","author":"Mpagama","year":"2023","journal-title":"Pilot Feasibility Stud."},{"key":"ref_13","first-page":"61","article-title":"Adverse Drug Reactions Among Patients Being Treated For Multi-Drug Resistant Tuberculosis in Nairobi City County Health Facilities","volume":"23","author":"Karimi","year":"2017","journal-title":"Pharmaceut. J. Kenya"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S2213-2600(20)30047-3","article-title":"Drug-associated adverse events in the treatment of multidrug-resistant tuberculosis: An individual patient data meta-analysis","volume":"8","author":"Lan","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1055\/s-0040-1722535","article-title":"Adverse Drug Reactions with First-Line and Second-Line Drugs in Treatment of Tuberculosis","volume":"57","author":"Prasad","year":"2021","journal-title":"Ann. Natl. Acad. Med. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ten\u00f3rio, M.C.d.S., Graciliano, N.G., Moura, F., de Oliveira, A.C.M., and Goulart, M.O.F. (2021). N-Acetylcysteine (NAC): Impacts on Human Health. Antioxidants, 10.","DOI":"10.3390\/antiox10060967"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Mapamba, D.A., Sauli, E., Mrema, L., Lalashowi, J., Magombola, D., Buza, J., Olomi, W., Wallis, R.S., and Ntinginya, N.E. (2022). Impact of N-Acetyl Cysteine (NAC) on Tuberculosis (TB) Patients\u2014A Systematic Review. Antioxidants, 11.","DOI":"10.3390\/antiox11112298"},{"key":"ref_18","first-page":"5907839","article-title":"N-Acetyl Cysteine as an Adjunct in the Treatment of Tuberculosis","volume":"2020","author":"Ejigu","year":"2020","journal-title":"Tuberc. Res. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4103\/2229-3485.210450","article-title":"N-acetylcysteine as an add-on to Directly Observed Therapy Short-I therapy in fresh pulmonary tuberculosis patients: A randomized, placebo-controlled, double-blinded study","volume":"8","author":"Mahakalkar","year":"2017","journal-title":"Perspect. Clin. Res."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Safe, I.P., Lacerda, M.V.G., Printes, V.S., Marins, A.F.P., Rabelo, A.L.R., Costa, A.A., Tavares, M.A., Jesus, J.S., Souza, A.B., and Beraldi-Magalh\u00e3es, F. (2020). Safety and efficacy of N-acetylcysteine in hospitalized patients with HIV-associated tuberculosis: An open-label, randomized, phase II trial (RIPENACTB Study). PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0235381"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.ekir.2020.11.018","article-title":"A Systematic Review of the Effect of N-Acetylcysteine on Serum Creatinine and Cystatin C Measurements","volume":"6","author":"Huang","year":"2021","journal-title":"Kidney Int. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e039009","DOI":"10.1136\/bmjopen-2020-039009","article-title":"Effect of N-acetylcysteine on prevention of contrast-associated acute kidney injury in patients with STEMI undergoing primary percutaneous coronary intervention: A systematic review and meta-analysis of randomised controlled trials","volume":"10","author":"Guo","year":"2020","journal-title":"BMJ Open"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1177\/0003319720950162","article-title":"Latest Clinical Evidence About Effect of Acetylcysteine on Preventing Contrast-Induced Nephropathy in Patients Undergoing Angiography: A Meta-Analysis","volume":"72","author":"Xie","year":"2021","journal-title":"Angiology"},{"key":"ref_24","first-page":"5301","article-title":"Role of N-acetylcysteine(NAC) in preventing development of anti tuberculosis therapy(ATT) induced liver injury in pulmonary tuberculosis(PTB) patients, a simple randomized single blind clinical trial","volume":"56","author":"Ahmed","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sanabria-Cabrera, J., Tabbai, S., Niu, H., Alvarez-Alvarez, I., Licata, A., Bj\u00f6rnsson, E., Andrade, R.J., and Lucena, M.I. (2022). N-Acetylcysteine for the Management of Non-Acetaminophen Drug-Induced Liver Injury in Adults: A Systematic Review. Front. Pharmacol., 13.","DOI":"10.3389\/fphar.2022.876868"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.ijtb.2022.05.012","article-title":"A study to evaluate the hepatoprotective effect of N- acetylcysteine on anti tuberculosis drug induced hepatotoxicity and quality of life","volume":"70","author":"Sukumaran","year":"2023","journal-title":"Indian J. Tuberc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e054434","DOI":"10.1136\/bmjopen-2021-054434","article-title":"Implementation of the \u2018Removed Injectable modified Short-course regimens for EXpert Multidrug Resistant Tuberculosis\u2019 (RISE study) in Tanzania: A protocol for a mixed-methods process evaluation","volume":"12","author":"Kalolo","year":"2022","journal-title":"BMJ Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1016\/j.athoracsur.2014.01.056","article-title":"High Dose of N-Acetylcystein Prevents Acute Kidney Injury in Chronic Kidney Disease Patients Undergoing Myocardial Revascularization","volume":"97","author":"Gowdak","year":"2014","journal-title":"Ann. Thorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1186\/s13019-021-01550-7","article-title":"The effect of N-acetyl cysteine injection on renal function after coronary artery bypass graft surgery: A randomized double blind clinical trial","volume":"16","author":"Javaherforooshzadeh","year":"2021","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_30","first-page":"1631","article-title":"Study of The Effects of N-Acetylcysteine on Oxidative Stress Status of Patients on Maintenance-Hemodialysis Undergoing Cadaveric Kidney Transplantation","volume":"16","author":"Modarresi","year":"2017","journal-title":"Iran J. Pharm. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1016\/j.ekir.2024.07.020","article-title":"N-acetylcysteine in Kidney Disease: Molecular Mechanisms, Pharmacokinetics, and Clinical Effectiveness","volume":"9","author":"Hammami","year":"2024","journal-title":"Kidney Int. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s11255-022-03455-3","article-title":"N-Acetylcysteine: More than preventing contrast-induced nephropathy in uremic patients\u2014Focus on the antioxidant and anti-inflammatory properties","volume":"55","author":"Cepaityte","year":"2023","journal-title":"Int. Urol. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2182","DOI":"10.1046\/j.1523-1755.2003.00322.x","article-title":"The effect of N-acetylcysteine on renal function, nitric oxide, and oxidative stress after angiography","volume":"64","author":"Efrati","year":"2003","journal-title":"Kidney Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"138","DOI":"10.5761\/atcs.oa.21-00132","article-title":"N-Acetylcysteine\u2019s Renoprotective Effect in Cardiac Surgery: A Systematic Review and Meta-Analysis","volume":"28","author":"Tan","year":"2022","journal-title":"Ann. Thorac. Cardiovasc. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1056\/NEJMoa2117166","article-title":"A 24-Week, All-Oral Regimen for Rifampin-Resistant Tuberculosis","volume":"387","author":"Berry","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_36","first-page":"e4071","article-title":"Determining the Incidence of Acute Kidney Injury Using the RIFLE Criteria in the Medical Intensive Care Unit in a Tertiary Care Hospital Setting in Pakistan","volume":"11","author":"Hussain","year":"2019","journal-title":"Cureus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1159\/000523828","article-title":"A Comparison of AKIN, KDIGO, and RIFLE Definitions to Diagnose Acute Kidney Injury and Predict the Outcomes after Cardiac Surgery in a South Asian Cohort","volume":"12","author":"Yaqub","year":"2022","journal-title":"Cardiorenal Med."},{"key":"ref_38","unstructured":"(2024, June 29). Acute Kidney Injury\u2014ClinicalKey, Available online: https:\/\/www.clinicalkey.com\/#!\/content\/playContent\/1-s2.0-S0140673619325632?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0140673619325632%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Amaral, E.P., Concei\u00e7\u00e3o, E.L., Costa, D.L., Rocha, M.S., Marinho, J.M., Cordeiro-Santos, M., D\u2019imp\u00e9rio-Lima, M.R., Barbosa, T., Sher, A., and Andrade, B.B. (2016). N-acetyl-cysteine exhibits potent anti-mycobacterial activity in addition to its known anti-oxidative functions. BMC Microbiol., 16.","DOI":"10.1186\/s12866-016-0872-7"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1097\/MEG.0b013e32833aa11b","article-title":"Protective effect of N-acetylcysteine on antituberculosis drug-induced hepatotoxicity","volume":"22","author":"Baniasadi","year":"2010","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_41","first-page":"432","article-title":"The effects of N-acetylcysteine on hepatic, hematologic, and renal parameters in cirrhotic patients: A randomized controlled trial","volume":"16","author":"Hatami","year":"2023","journal-title":"Gastroenterol. Hepatol Bed Bench."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Popescu, M., Bratu, A., Agapie, M., Borjog, T., Jafal, M., Sima, R.-M., and Orban, C. (2024). The Use and Potential Benefits of N-Acetylcysteine in Non-Acetaminophen Acute Liver Failure: An Etiology-Based Review. Biomedicines, 12.","DOI":"10.3390\/biomedicines12030676"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/j.1440-1843.2006.00941.x","article-title":"Antituberculosis drugs and hepatotoxicity","volume":"11","author":"Yew","year":"2006","journal-title":"Respirology"},{"key":"ref_44","first-page":"e920350-1","article-title":"Drug-Induced Liver Injury from Anti-Tuberculosis Treatment: A Retrospective Cohort Study","volume":"26","author":"Zhao","year":"2020","journal-title":"Med. Sci. Monit."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1017\/S0007114510003636","article-title":"Weight loss during tuberculosis treatment is an important risk factor for drug-induced hepatotoxicity","volume":"105","author":"Warmelink","year":"2011","journal-title":"Br. J. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Guerini, M., Condr\u00f2, G., Friuli, V., Maggi, L., and Perugini, P. (2022). N-acetylcysteine (NAC) and Its Role in Clinical Practice Management of Cystic Fibrosis (CF): A Review. Pharmaceuticals, 15.","DOI":"10.3390\/ph15020217"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.curtheres.2016.06.001","article-title":"Effervescent N-Acetylcysteine Tablets versus Oral Solution N-Acetylcysteine in Fasting Healthy Adults: An Open-Label, Randomized, Single-Dose, Crossover, Relative Bioavailability Study","volume":"83","author":"Greene","year":"2016","journal-title":"Curr. Ther. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"102244","DOI":"10.1016\/j.tube.2022.102244","article-title":"Immunologic and imaging signatures in post tuberculosis lung disease","volume":"136","author":"Singh","year":"2022","journal-title":"Tuberculosis"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"170077","DOI":"10.1183\/16000617.0077-2017","article-title":"Tuberculosis and lung damage: From epidemiology to pathophysiology","volume":"27","author":"Ravimohan","year":"2018","journal-title":"Eur. Respir. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"110817","DOI":"10.1016\/j.cbi.2023.110817","article-title":"Post-tuberculosis lung disease and inflammatory role players: Can we characterise the myriad inflammatory pathways involved to gain a better understanding?","volume":"387","author":"Malefane","year":"2023","journal-title":"Chem. Interactions"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"evidoa2300332","DOI":"10.1056\/EVIDoa2300332","article-title":"Adjunctive N-Acetylcysteine and Lung Function in Pulmonary Tuberculosis","volume":"3","author":"Wallis","year":"2024","journal-title":"NEJM Evid."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s40264-020-01026-y","article-title":"Safety of N-Acetylcysteine at High Doses in Chronic Respiratory Diseases: A Review","volume":"44","author":"Calverley","year":"2021","journal-title":"Drug Saf."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1164\/rccm.201505-1010OC","article-title":"TOLLIP, MUC5B, and the Response to N-Acetylcysteine among Individuals with Idiopathic Pulmonary Fibrosis","volume":"192","author":"Oldham","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e2220671","DOI":"10.1001\/jamanetworkopen.2022.20671","article-title":"Meta-analytic Techniques to Assess the Association Between N-acetylcysteine and Acute Kidney Injury After Contrast Administration","volume":"5","author":"Magner","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1016\/j.ekir.2021.04.006","article-title":"N-Acetylcysteine Interference With Creatinine Measurement: An In Vitro Analysis","volume":"6","author":"McCudden","year":"2021","journal-title":"Kidney Int. Rep."}],"container-title":["Pharmaceutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4923\/17\/4\/516\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:14:42Z","timestamp":1760030082000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4923\/17\/4\/516"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":55,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["pharmaceutics17040516"],"URL":"https:\/\/doi.org\/10.3390\/pharmaceutics17040516","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2025.01.15.25320552","asserted-by":"object"}]},"ISSN":["1999-4923"],"issn-type":[{"value":"1999-4923","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,15]]}}}