metronidazole + N-acetyl cysteine

Metronidazole + N-acetyl cysteine is a combination therapy consisting of two agents with complementary mechanisms. Metronidazole is a nitroimidazole antibiotic and antiprotozoal agent that acts by disrupting DNA synthesis in anaerobic bacteria and certain protozoa, leading to cell death. It is widely used for the treatment of various anaerobic infections, including bacterial vaginosis, trichomoniasis, amebiasis, and other gastrointestinal or gynecological infections[6][10]. N-acetyl cysteine (NAC) is an antioxidant and precursor to glutathione with mucolytic properties; it acts as a sulfide-buffering agent by replenishing intracellular glutathione stores. NAC has been shown to have antibacterial activity against some pathogens (notably in biofilm prevention), anti-inflammatory effects, and can modulate oxidative stress[2][5][9]. The combination has been studied primarily for ethylmalonic encephalopathy—a rare mitochondrial disorder caused by ETHE1 mutations—where it addresses both the overproduction of toxic sulfide (by reducing its generation via gut flora suppression with metronidazole) and enhances detoxification capacity (via glutathione replenishment from NAC). This dual approach has demonstrated additive benefits in preclinical models as well as marked clinical improvement in affected children[1][3][4][7][8]. The combination is also under investigation for use in bacterial vaginosis due to potential synergistic effects on biofilm disruption and infection control[5].

Other names

metronidazole and N-acetylcysteinemetronidazole plus NAC