ReviewBiofilm2026
N-acetylcysteine as an adjunct to antibiotics against bacterial biofilms: A systematic review of in vitro evidence.
Review in Biofilm, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: N-acetylcysteine (NAC) is investigated as an antibiotic adjunct, but acidity, formulation and experimental context complicate interpretation. We evaluated comparative in-vitro evidence while distinguishing biofilm prevention, established-biofilm treatment and resistance evolution. Methods: MEDLINE/PubMed, Embase, Scopus and Web of Science were searched through August 2026, with supplementary searching. Extraction distinguished NAC preparation and exposure pH, medium, hydrodynamics, NAC-alone controls, treatment intent and interaction methodology. Results were synthesized by experimental context, regimen, phase and endpoint without pooling or whole-study efficacy voting. Results: Fifty-five studies were included: 7 evaluated combination exposure during formation only, 37 after establishment only, 9 both, and 2 resistance evolution. NAC-alone arms were documented in 39 studies, partial or formulation-specific in 9, and not identified in 7. Only two studies included a continuous-flow model. Selected combinations improved biofilm-associated outcomes, but intrinsic-acidic and neutralized preparations, biomass and viability endpoints, and planktonic versus biofilm interaction tests were not interchangeable. Liposomal and catheter-lock findings differed by dose matching, isolate and control set. Polymyxin findings varied with organism, resistance background, medium and exposure; rifampicin-alone and rifampicin-containing multidrug comparators addressed different questions. Conclusions: NAC is a context-dependent experimental adjunct, not an established class-wide antibiotic potentiator. The evidence does not support clinical antibiotic dose reduction or routine NAC combination therapy. Translation requires controlled final exposure pH, matched monotherapy and formulation controls, clinically relevant background regimens, viable-burden and regrowth outcomes, and resistance monitoring.
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Registered trials
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