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n-acetylcysteine + PPI + amoxicillin + clarithromycin is a combination drug regimen investigated for the first-line eradication of Helicobacter pylori infection. The regimen, often referred to as NAC-augmented triple therapy (NAC-T14), typically consists of the mucolytic agent N-acetylcysteine (NAC), a proton pump inhibitor (PPI) such as dexlansoprazole, and the antibiotics amoxicillin and clarithromycin. NAC is included to disrupt the H. pylori biofilm and mucus layer, which is thought to protect the bacteria from antibiotics and contribute to treatment failure. The PPI component reduces gastric acid secretion by inhibiting the H+/K+-ATPase, thereby increasing gastric pH and stabilizing the antibiotics. Amoxicillin and clarithromycin provide the primary antimicrobial activity by inhibiting bacterial cell wall synthesis and protein synthesis, respectively. Clinical trials, including a multicenter study by National Taiwan University Hospital, have evaluated this regimen's efficacy compared to standard triple therapy, particularly in the context of rising antibiotic resistance.
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