Hooshmand Gharabagh Laya, Heydaroghli Mehdi, Esmaeili Ayda
Department of Internal Medicine, School of Medicine, Urmia University of Medical Sciences, Imam Khomeini Hospital, Urmia, Iran.
Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.
Arch Iran Med. 2025 May 1;28(5):257-263. doi: 10.34172/aim.33355.
Biofilm formation by bacteria on the lower limb arises from reduced peripheral arterial blood flow, which can lead to the failure of antibiotic therapy or require longer duration of intravenous antibiotic therapy in diabetic foot infection-associated osteomyelitis. N-acetyl cysteine (NAC), an agent known to prevent and treat biofilm-related infections, was used as a novel strategies beside antibiotic therapy in osteomyelitis of diabetic foot with the aim of accelerating the response to antibiotic therapy regimen.
To assess the synergistic effect of NAC with antibiotic therapy, patients with diabetic foot osteomyelitis (DFO) (grade III or IV Wagner) were randomly assigned to either NAC 600 mg effervescent tablet twice daily for 2 weeks or the control group. Clinical and laboratory data, including white blood cell with differentiation and inflammatory factors (ESR and CRP) were measured at baseline (time 0), after one week and after three weeks of initiating the intervention.
Fifty-three eligible patients completed the study. All evaluated infectious-related laboratory parameters showed significant reductions in the NAC group compared to control (<0.05), except for lymphocyte proportion and NLR (P; 0.11 and 0.84, respectively). The drop rate of ESR and CRP were accelerated by NAC compared to the control group (-49.44±6.04 vs -7.17±3.99; -44.43±4.21 vs -14.02±4.05, respectively, <0.05).
In order to accelerate antibiotic responses and the trend of reduction in infectious inflammatory markers during the therapy, oral NAC 600 mg twice daily may be considered in the treatment protocol of patients with DFO.
细菌在下肢形成生物膜源于外周动脉血流减少，这可能导致抗生素治疗失败，或在糖尿病足感染相关骨髓炎中需要更长疗程的静脉抗生素治疗。N - 乙酰半胱氨酸（NAC）是一种已知可预防和治疗生物膜相关感染的药物，在糖尿病足骨髓炎的治疗中，除抗生素治疗外，它被用作一种新策略，目的是加快对抗生素治疗方案的反应。
为评估NAC与抗生素治疗的协同作用，将糖尿病足骨髓炎（DFO）（Wagner分级III级或IV级）患者随机分为两组，一组每日两次服用600 mg泡腾片NAC，共2周，另一组为对照组。在基线（时间0）、干预开始1周后和3周后测量临床和实验室数据，包括白细胞分类及炎症因子（血沉和C反应蛋白）。
53例符合条件的患者完成了研究。与对照组相比，NAC组所有评估的感染相关实验室参数均显著降低（<0.05），但淋巴细胞比例和中性粒细胞与淋巴细胞比值（NLR）除外（P值分别为0.11和0.84）。与对照组相比，NAC加速了血沉和C反应蛋白的下降速度（分别为-49.44±6.04对-7.17±3.99；-44.43±4.21对-14.02±4.05，<0.05）。
为了在治疗期间加快抗生素反应以及感染性炎症标志物的下降趋势，在DFO患者的治疗方案中可考虑每日两次口服600 mg NAC。
