High-dose N-acetylcysteine therapy in the treatment of pneumonia


  • Dmytro Dmytriiev National Pirogov Memorial Medical University, Vinnytsia
  • Oleksandr Nazarchuk National Pirogov Memorial Medical University, Vinnytsia
  • Yuliana Babina National Pirogov Memorial Medical University, Vinnytsia




COVID-19, N-acetylcysteine, pneumonia


The article presents modern data on the use of N-acetylcysteine in the treatment of infectious diseases of the respiratory tract in the practice of a physician. Its antioxidant, mucolytic, anti-inflammatory, pulmoprotective and antitoxic properties are described. The emphasis is placed on the antioxidant properties of N-acetylcysteine, which are expressed when used in high doses of 1200 mg/day or more. There is a review of the literature on the use of high doses of N-acetylcysteine in the treatment of pneumonia, cystic fibrosis, COPD, ARDS. The effect of N-acetylcysteine on individual risk factors for prolonged pneumonia is analyzed. Given the epidemiological situation around the world, the antioxidant properties of N-acetylcysteine in the treatment of pneumonia, including complicated COVID-19, are relevant and require further study.


Download data is not yet available.


Hurst JR, Verma N, Lowe D, Baxendale HE, Jolles S, Kelleher P, et al. British Lung Foundation/United Kingdom Primary Immunodeficiency Network Consensus Statement on the Definition, Diagnosis, and Management of Granulomatous-Lymphocytic Interstitial Lung Disease in Common Variable Immunodeficiency Disorders. The Journal of Allergy and Clinical Immunology: In Practice [Internet]. Elsevier BV; 2017 Jul;5(4):938–45. Available from: https://doi.org/10.1016/j.jaip.2017.01.021

Martin-Loeches I, Torres A, Rinaudo M, Terraneo S, de Rosa F, Ramirez P, et al. Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms. Journal of Infection [Internet]. Elsevier BV; 2015 Mar;70(3):213–22. Available from: https://doi.org/10.1016/j.jinf.2014.10.004

Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, Reed C, Grijalva CG, Anderson EJ, Courtney DM, Chappell JD. Community-acquired pneumonia requiring hospitalization among US adults. New England Journal of Medicine. 2015 Jul 30;373(5):415-27.

Kireev IV, et al. Analysis of drug prescriptions for patients with community-acquired pneumonia in the hospital. 2017. Available from:

Zubkov МN. Modern problems of resistance of pneumotropic pathogens [Sovremennye problemy rezistentnosti pnevmotropnyh patogenov]. Pulmonology; 2007;5:6-14. [In Russian]

Johnstone J, Majumdar SR, Fox JD, Marrie TJ. Viral Infection in Adults Hospitalized With Community-Acquired Pneumonia. Chest [Internet]. Elsevier BV; 2008 Dec;134(6):1141–8. Available from: https://doi.org/10.1378/chest.08-0888

Semash NA. The use of high doses of K-acetylcysteine in moderate pneumonia [Primenenie vysokih doz K-Acetilcisteina pri srednetyazheloj pnevmonii]. Moscow: Federal State Budgetary Institution "Research Institute of Pulmonology" of the Federal Medical and Biological Agency of Russia and the Federal State Institution "Central Clinical Military Hospital of the Federal Security Service of the Russian Federation". 2013.3-4. Available from: http://medical-diss.com/medicina/primenenie-vysokih-doz-n-atsetiltsisteina-pri-srednetyazheloy-pnevmonii [In Russian]

Markelova EV, Kostyushko AV, Krasnikov VE. Pathogenetic role of disorders in the cytokine system in infectious and inflammatory diseases [Patogeneticheskaya rol' narushenij v sisteme citokinov pri infekcionno-vospalitel'nyh zabolevaniyah]. Pacific Medical Journal, 2008, 3 (33). [In Russian]

Avdeev SN, Baymakanova GE. COPD and cardiovascular disease: mechanisms of association [HOBL i serdechno-sosudistye zabolevaniya: mekhanizmy associacii]. Pulmonology; 2020;1:5-13. [In Russian]

Grigorieva NU. Acetylcysteine: Proven Benefits and Future Directions [Acetilcistein: dokazannaya pol'za i perspektivnye napravleniya]. Russian medical journal. Medical Review; 2013;21(26):1256-1259. [In Russian]

Aruoma OI, Halliwell B, Hoey BM, Butler J. The antioxidant action of N-acetylcysteine: Its reaction with hydrogen peroxide, hydroxyl radical, superoxide, and hypochlorous acid. Free Radical Biology and Medicine [Internet]. Elsevier BV; 1989 Jan;6(6):593–7. Available from: https://doi.org/10.1016/0891-5849(89)90066-x

Ovcharenko SI. Mucolytic (mucoregulatory) drugs in the treatment of chronic obstructive pulmonary disease [Mukoliticheskie (mukoregulyatornye) preparaty v lechenii hronicheskoj obstruktivnoj bolezni legkih]. 2002; 10. No. 4: 153-157. [In Russian]

Barnes PJ. Histone acetylation and deacetylation: importance in inflammatory lung diseases. European Respiratory Journal [Internet]. European Respiratory Society (ERS); 2005 Mar 1;25(3):552–63. Available from: https://doi.org/10.1183/09031936.05.00117504

Beketova GV, Soldatova OV. Acetylcysteine: modern possibilities for use in practice of pediatricians and family doctors. SOVREMENNAYA PEDIATRIYA [Internet]. Group of Companies Med Expert, LLC; 2018 Nov 30;(7(95)):69–76. Available from: https://doi.org/10.15574/sp.2018.95.69

Jorge-Aarón R-M, Rosa-Ester M-P. N-acetylcysteine as a potential treatment for COVID-19. Future Microbiology [Internet]. Future Medicine Ltd; 2020 Jul;15(11):959–62. Available from: https://doi.org/10.2217/fmb-2020-0074

Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. Gallagher T, editor. Journal of Virology [Internet]. American Society for Microbiology; 2020 Mar 17;94(7). Available from: https://doi.org/10.1128/jvi.00127-20

Kumar S, Maurya VK, Prasad AK, Bhatt MLB, Saxena SK. Structural, glycosylation and antigenic variation between 2019 novel coronavirus (2019-nCoV) and SARS coronavirus (SARS-CoV). VirusDisease [Internet]. Springer Science and Business Media LLC; 2020 Mar;31(1):13–21. Available from: https://doi.org/10.1007/s13337-020-00571-5

Hoffmann M, Kleine-Weber H, Pöhlmann S. A Multibasic Cleavage Site in the Spike Protein of SARS-CoV-2 Is Essential for Infection of Human Lung Cells. Molecular Cell [Internet]. Elsevier BV; 2020 May;78(4):779–784.e5. Available from: https://doi.org/10.1016/j.molcel.2020.04.022

Aldini G, Altomare A, Baron G, Vistoli G, Carini M, Borsani L, et al. N-Acetylcysteine as an antioxidant and disulphide breaking agent: the reasons why. Free Radical Research [Internet]. Informa UK Limited; 2018 May 9;52(7):751–62. Available from: https://doi.org/10.1080/10715762.2018.1468564

Dinicola S, De Grazia S, Carlomagno G, Pintucci JP. N-acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review. Eur Rev Med Pharmacol Sci. 2014 Oct 1;18(19):2942-8.

Stav D, Raz M. Effect of N-Acetylcysteine on Air Trapping in COPD. Chest [Internet]. Elsevier BV; 2009 Aug;136(2):381–6. Available from: https://doi.org/10.1378/chest.09-0421

Dauletbaev N, Fischer P, Aulbach B, Gross J, Kusche W, Thyroff-Friesinger U, et al. A phase II study on safety and efficacy of high-dose N-acetylcysteine in patients with cystic fibrosis. European Journal of Medical Research [Internet]. Springer Science and Business Media LLC; 2009 Aug 12;14(8). Available from: https://doi.org/10.1186/2047-783x-14-8-352

Conrad C, Lymp J, Thompson V, Dunn C, Davies Z, Chatfield B, et al. Long-term treatment with oral N-acetylcysteine: Affects lung function but not sputum inflammation in cystic fibrosis subjects. A phase II randomized placebo-controlled trial. Journal of Cystic Fibrosis [Internet]. Elsevier BV; 2015 Mar;14(2):219–27. Available from: https://doi.org/10.1016/j.jcf.2014.08.008

Zheng J-P, Wen F-Q, Bai C-X, Wan H-Y, Kang J, Chen P, et al. Twice daily N-acetylcysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON): a randomised, double-blind placebo-controlled trial. The Lancet Respiratory Medicine [Internet]. Elsevier BV; 2014 Mar;2(3):187–94. Available from: https://doi.org/10.1016/s2213-2600(13)70286-8

Chalumeau M, Duijvestijn YC. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochrane Database of Systematic Reviews [Internet]. Wiley; 2013 May 31; Available from: https://doi.org/10.1002/14651858.cd003124.pub4

Avdeev SN, et al. High doses of N-acetylcysteine in acute respiratory distress syndrome [Vysokie dozy N-acetilcisteina pri ostrom respiratornom distress-sindrome]. Pulmonology; 2010;3:31-38. [In Russian]

Horowitz RI, Freeman PR, Bruzzese J. Efficacy of glutathione therapy in relieving dyspnea associated with COVID-19 pneumonia: A report of 2 cases. Respiratory Medicine Case Reports [Internet]. Elsevier BV; 2020;30:101063. Available from: https://doi.org/10.1016/j.rmcr.2020.101063

McCarty MF, DiNicolantonio JJ. Nutraceuticals have potential for boosting the type 1 interferon response to RNA viruses including influenza and coronavirus. Progress in Cardiovascular Diseases [Internet]. Elsevier BV; 2020 May;63(3):383–5. Available from: https://doi.org/10.1016/j.pcad.2020.02.007

Fajgenbaum DC, Khor JS, Gorzewski A, Tamakloe M-A, Powers V, Kakkis JJ, et al. Treatments Administered to the First 9152 Reported Cases of COVID-19: A Systematic Review. Infectious Diseases and Therapy [Internet]. Springer Science and Business Media LLC; 2020 May 27;9(3):435–49. Available from: https://doi.org/10.1007/s40121-020-00303-8

De Flora S, Balansky R, La Maestra S. Rationale for the use of N-acetylcysteine in both prevention and adjuvant therapy of COVID‐19. The FASEB Journal [Internet]. Wiley; 2020 Aug 11;34(10):13185–93. Available from: https://doi.org/10.1096/fj.202001807

Moradi M, Mojtahedzadeh M, Mandegari A, Soltan-Sharifi MS, Najafi A, Khajavi MR, et al. The role of glutathione-S-transferase polymorphisms on clinical outcome of ALI/ARDS patient treated with N-acetylcysteine. Respiratory Medicine [Internet]. Elsevier BV; 2009 Mar;103(3):434–41. Available from: https://doi.org/10.1016/j.rmed.2008.09.013

Register of medicines of ukraine. Electronic resource. Available from: http://www.drlz.Kiev.ua

Yakovleva OO, Pivtorak KV, Fejaga IV. Clinical pharmacology: drugs for the treatment of diseases of the digestive system. Nova Knyha; 2014. [In Ukrainian]

Prokhorov MP. Differential approach to the treatment of cough in children [Dyferentsiinyi pidkhid do likuvannia kashliu u ditei]. Immunology and allergology: science and practice. 2015;1:112-118. [In Ukrainian]

Resolution of the Cabinet of Ministers of Ukraine. Available from: https://zakon.rada.gov.ua/laws/show/1033-2020-п

Високодозова терапія N-ацетилцистеїном у лікуванні  пневмонії



How to Cite

Dmytriiev D, Nazarchuk O, Babina Y. High-dose N-acetylcysteine therapy in the treatment of pneumonia. prmd [Internet]. 2021 May 20 [cited 2021 Aug. 4];4(1):4-10. Available from: https://perioperative.org.ua/index.php/prtmdc/article/view/53

Most read articles by the same author(s)