n-acetylcysteine + dexlansoprazole + amoxicillin + clarithromycin

This investigational combination therapy regimen, developed by the National Taiwan University Hospital, is designed for the first-line eradication of Helicobacter pylori infection. The regimen integrates four active components: N-acetylcysteine (NAC), which acts as a biofilm-destabilizing agent to disrupt the protective bacterial matrix; dexlansoprazole, a proton pump inhibitor that reduces gastric acid secretion to optimize antibiotic efficacy; and two antibiotics, amoxicillin and clarithromycin, which target bacterial cell wall synthesis and protein synthesis, respectively. Despite the rationale that NAC could overcome antibiotic resistance by breaking down biofilms, a Phase 4 multicenter randomized controlled trial (NCT02249546) involving 680 patients demonstrated that the addition of NAC to standard triple therapy did not significantly improve eradication rates compared to triple therapy alone.

Brand names

ActeinDexilantKlaricid XL

Other names

NAC-containing triple therapyN-acetylcysteine + PPI-amoxicillin-clarithromycinTriple therapy with or without acetylcysteine