Arch Iran Med. 2020;23(6): 397-402.
doi: 10.34172/aim.2020.33
  Abstract View: 241
  PDF Download: 97

Original Article

Effect of N-acetylcysteine against Vancomycin-Induced Nephrotoxicity: A Randomized Controlled Clinical Trial

Shirinsadat Badri 1,2 ORCID logo, Rasool Soltani 1 * ORCID logo, Mina Sayadi 3, Farzin Khorvash 4,5, Mohsen Meidani 4, Shahram Taheri 2

1 Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
2 Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Students Research Committee, Faculty of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Infectious Diseases, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
5 Nosocomial Infections Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
*Corresponding Author: Rasool Soltani, PhD; School of Pharmacy and Pharmaceutical Sciences. Isfahan University of Medical Sciences, Hezar Jarib Ave. Isfahan, Iran. Tel: +98-31 37927067; Fax: +98-31 36680011; Email: soltani@pharm.mui.ac.ir


Background: The proposed mechanism of vancomycin-induced nephrotoxicity (VIN) is indirect production of reactive oxygen species in the kidney tissue. This study aimed to investigate the effectiveness of N-acetylcysteine (NAC), an anti-oxidant agent, in the prevention of VIN.

Methods: Patients who received vancomycin for any indication were randomly divided to drug (NAC) and control groups. The patients in the drug group received oral NAC 600 mg every 12 hours for 10 days, starting concurrently with vancomycin. Serum creatinine (SCr) levels and blood urea nitrogen (BUN) as well as creatinine clearance (CrCl) and 12-hour urine volume were recorded at baseline, every other day during the study, and 12 hours after the last dose of vancomycin on the 10th day. Furthermore, the cases of acute kidney injury (AKI; ≥ 0.5 mg/dL or at least 50% increase in serum creatinine from baseline) were recorded in the two groups.

Results: Over the study period, 84 and 95 patients completed the study in drug and control groups, respectively. SCr and CrCl were significantly lower and higher, respectively, at all-time points (except for baseline) in the NAC compared to the control group. Furthermore, although not statistically significant, 12 cases of vancomycin-induced AKI were observed in the control group (12.63%), while 4 cases (4.76%) were reported from drug group (P = 0.066; relative risk [RR] = 0.377, 95% CI: 0.126–1.124).

Conclusion: NAC has the potential for reduction of VIN. However, more studies are necessary to confirm this effect.

Keywords: Clinical trial, N-acetylcysteine, Nephrotoxicity, Reactive oxygen species, Vancomycin
Cite this article as: Badri S, Soltani R, Sayadi M, Khorvash F, Meidani M, Taheri S. Effect of N-acetylcysteine against vancomycininduced nephrotoxicity: a randomized controlled clinical trial. Arch Iran Med. 2020;23(6):397–402. doi: 10.34172/aim.2020.33.
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Abstract View: 241

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Submitted: 25 Feb 2019
Accepted: 21 Jan 2020
ePublished: 01 Jun 2020
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