Intervention Review

You have free access to this content

Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease

  1. Martin Chalumeau1,*,
  2. Yvonne CM Duijvestijn2

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 31 MAY 2013

Assessed as up-to-date: 6 MAR 2013

DOI: 10.1002/14651858.CD003124.pub4

How to Cite

Chalumeau M, Duijvestijn YCM. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD003124. DOI: 10.1002/14651858.CD003124.pub4.

Author Information

  1. 1

    Necker Hospital, AP-HP and Paris Descartes University, INSERM U953 and Department of Pediatrics, Paris, France

  2. 2

    Medical Centre Alkmaar, Department of Paediatrics (119), Alkmaar, Netherlands

*Martin Chalumeau, INSERM U953 and Department of Pediatrics, Necker Hospital, AP-HP and Paris Descartes University, Paris, France.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions), comment added to review
  2. Published Online: 31 MAY 2013



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Bellomo 1972 {published data only}
  • Bellomo G, Giudice S. Controlled study on the efficacy of a combination "thiamphenicol-acetylcysteine" in oral administration in respiratory infections in pediatrics [Studio controllata sull'efficacia della combinazione "tiamfenicolo-acetilcisteina" per via orale nel trattamento delle infezioni broncopolmonari dell'infanzia]. Clinical Pediatrics 1972;54:30-51.
Biscatti 1972 {published data only}
  • Biscatti G, Bruschelli M, Damonte G, Capozzi F. Controlled studies of the clinical effects of acetylcysteine in oral administration in respiratory infections in pediatrics [Ricerca controllata sugli effetti clinici dell'acetilcisteina per via orale nelle infezioni respiratorie in pediatria]. Minerva Pediatrica 1972;24:1075-84.
Fiocchi 1989 {published data only}
  • Fiocchi A, Vignati B, Sala M, Arancio R, Banderali G, Marangione P, et al. A new n-acetylcysteine formulation in acute bronchopneumopathy in children [La n-acetilcisteina nel trattamento delle broncopneumopatie acute in pediatria]. Giornale Italiano delle Malattie del Torace 1989;43:327-34.
Malka 1990 {published data only}
  • Malka M, Lablache Combier B. Carbocysteine in the treatment of acute bronchitis in children [Interet d'un mucolytique, la carbocistéine, dans la bronchite aiguë de l'enfant]. Medicina Infantil 1990;97:687-92.
Nakayama 1977 {published data only}
  • Nakayama Y, Maeda K, Fuanabashi S, Kubagawa T, Simanugi K, Tateno K, et al. Carbocysteine syrup in pediatrics: a clinical trial [Effets cliniques de s-carboxymethylcysteine sous forme de sirop en pédiatrie (traduction)]. Japanese Journal of Pediatrics 1977;10:1823.
Zanini 1974 {published data only}
  • Zanini A, Dodesni G. Lisomucil in pediatrics [Il lisomucil in campo pediatrico]. Clinica Europea 1974;13:1-12.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Amir 1985 {published data only}
  • Amir J, Wilunsky E, Zelikovic I, Reisner SH. Acetylcysteine for severe atelectasis in premature infants. Clinical Pharmacy 1985;4:255.
Anonymous 1987 {unpublished data only}
  • Anonymous. A study of tolerance of carbocisteine syrup in children [Etude de la tolérance clinique du sirop carbocistéine chez l'enfant]. Dossier d'autorisation de mise sur le marché, Laboratoires Alpharma, Aubervilliers, France 1987.
Baldini 1989 {published data only}
  • Baldini G, Gucci M, Taro D, Memmini C. Controlled clinical study of a new Ambroxol formula in the treatment of infantile spastic bronchitis [Studio clinico controllato sull'attivita di una nuova formulazione di Ambroxol nella bronchite asmatiforme del bambino]. Minerva Pediatrica 1989;41:91-5.
Banovcin 1990 {published data only}
  • Banovcin P. Efficacy of carbocysteine in the treatment of bronchopneumonias in children. Prakticky Lekar 1990;70:885-7.
Banovcin 1992 {published data only}
  • Banovcin P, Jakusova L, Rosslerova V, Miklerova M, Pullman R. Carbocysteine in the treatment of recurrent bronchitis in infants [Karbocystein v liecbe recidivujucich bronchitid u dojciat]. Ceskoslovenska Pediatrie 1992;47:543-6.
Bellomo 1967a {published data only}
  • Bellomo G, Frigerio G, Tirantello G. Controlled study on the use of intramuscular acetylcysteine in acute respiratory infections in pediatrics [Ricerche controllate sull'impiego dell'acetilcisteina per via intramuscolare nelle infezioni respiratorie acute in pediatria]. Clinica Terapeutica 1967;43:437-58.
Bellomo 1967b {published data only}
  • Bellomo G, Tirantello G, Giudice S. On the use of a combination of acetylcysteine with thiamphenicol glycinate in the systemic treatment of bronchopulmonary infections in children [Sull'uso di una combinazione dell'acetilcysteina con tiamfenicolo glicato nel trattamento sistemico delle infezioni broncopolmonari in eta' pediatrica]. Clinical Pediatrics 1967;49:402-24.
Bellomo 1973 {published data only}
  • Bellomo G, Giudice S, Ganci C. Comparative study of the efficacy of acetylcysteine by the oral and intramuscular routes in acute respiratory affections in pediatrics [Studio comparativo dell'efficacia dell'acetilcisteina per via orale ed intramuscolare nelle affezioni respiratorie acute in pediatria]. Minerva Pediatrica 1973;25:844-9.
Berger 1978 {published data only}
  • Berger von G, Gottschalk B, Leupold W. Initial experiences with ultrasonic aerosol therapy at home in children with bronchiectasis [Erste erfahrungen mit der ultraschall-aerosolbehandlung unter heimbedingungen bei kindern mit bronchiektasen]. Kinderärztliche Praxis 1978;46:523-7.
Berni 1983 {published data only}
  • Berni M, Collina A, Zavattini G. Ambroxol in bronchopulmonary pathology in children [Ambroxol nella patologia broncopolmonare del bambino]. Clinica Terapeutica 1983;106:351-5.
Boner 1984 {published data only}
  • Boner AL, Valletta EA, Stocchero L, Richelli C, Bennati D. Combined antibiotic plus mucolytic treatment of acute or recurrent pneumonia in children. Drugs Under Experimental and Clinical Research 1984;10:627-30.
Camurri 1990 {published data only}
  • Camurri S, Marenco G. Clinical evaluation of the safety and efficacy of a new pharmaceutical formulation of bromhexine compared to N-acetylcysteine in pediatric patients with acute bronchitis [Valutazione clinica dell'efficacia e della tollerabilita della nuova formulazione farmaceutica bromessina granulare nei confronti dell'N-acetilcisteina granulare in piccoli pazienti affetti da bronchite acuta]. Gazzetta Medica Italiana 1990;149:45-8.
Caramia 1984 {published data only}
  • Caramia G, Bizzarri V, Compagnoni L, Gregorini S. Combined antibiotic plus mucolytic treatment in broncho-pulmonary disease: cefuroxime plus acetylcysteine. Current Therapeutic Research, Clinical and Experimental 1984;36:658-63.
Careddu 1989 {published data only}
  • Careddu P, Bernocchi D, Scotti L, Manini G, Mezzopane A. Therapeutic activity and tolerability of a new mucoregulating drug called nesosteine in the treatment of acute diseases of the respiratory apparatus. Controlled pediatric study vs carbocysteine [Attivita terapeutica e tollerabilita di un nuovo farmaco mucoregolatore denominato nesosteina nel trattamento di affezioni acute dell'apparato respiratorio studio pediatrico controllato vs carbocisteina]. Giornale Italiano Delle Malattie Del Torace 1989;43:47-52.
Castello 1979 {published data only}
  • Castello D, Costa G, de Candussio G. Modifications in catarrhal bronchitis secretion in paediatric age following treatment with S-carboxymethyl-cystein (viscosimetric study) [Modificazioni dell'escreato nella bronchite catarrale in eta pediatrica dopo trattamento con S-carbossimetilcisteina (indagine viscosimetrica)]. Minerva Pediatrica 1979;31:371-80.
Chalumeau 2002 {published data only}
  • Chalumeau M, Cheron G, assathiany R, Moulin F, Bavoux F, Breart G, et al. Mucolytic agents for acute respiratory tract infections in infants: a pharmacoepidemiologic problem? [Fluidifiants bronchiques dans les infections respiratoires aiguës du nourrisson: un problème pharmacoépidémiologique?]. Archives de Pédiatrie 2002;9:1128-36.
Dano 1971 {published data only}
Egreteau 1992 {published data only}
  • Egreteau L, Gaillard D, Jouet JB, Plotkowski L, Zahm JM, Pierrot D, et al. Effect of carbocisteine on mucus and respiratory mucosa in children with recurrent bronchitis. European Respiratory Journal 1992;Suppl 5:301.
Gaudier 1968 {unpublished data only}
  • Gaudier B, Lelong M. Carbocysteine to treat asthma in children [L'utilisation de la S-Carboxy Methyl Cystéine (LJ 206) dans l'asthme de l'enfant]. Laboratoires Joullie, Paris 1968.
Ginocchi 1978 {published data only}
  • Ginocchi G. Clinical effects of a mucolytic agent (Pol 65) in a pediatric statistical study [Effeti clinici di un mucoliyico (Pol 65) in una casistica pediatrica]. Settimana Medica 1978;66:391-408.
Gusberti 1985 {published data only}
  • Gusberti C, Bellazzi A, Lonati C, Modesti R. Clinical evaluation of a new synthetic derivative of acetylcysteine for treating respiratory inflammations in pediatric patients [Valutazione clinica di uno nuovo derivato sintetico dell'acido acetilsalicilico nella terapia di flogosi respiratorie di pazienti pediatrici]. Archivio di Medicina Interna 1985;37:123-9.
Henocq 1985 {published data only}
  • Henocq A, Moreau C, Mallet E, Sauger F, Menibus CH de. Changes in IgA levels in nasal mucus after upper respiratory tract diseases in infants treated with carbocysteine [Modifications du taux IgA du mucus nasal au décours des affections des voies aériennes supérieures du nourrisson traitées par la carbocistéine]. Annales d'Oto-Laryngologie et de Chirurgie Cervico Faciale 1985;102:373-5.
Hofmann 1980 {published data only}
  • Hofmann A. Oral acetylcystein in the treatment of bronchial asthma and chronic respiratory tract diseases [Orale anwendung von acetylcystein bei der behandlung von asthma bronchiale und chronischen erkrankungen der luftwege]. Therapiewoche 1980;30:2040-6.
Jean 1982 {unpublished data only}
  • Jean R, Gardair F. Efficacy on expectoration of acetylcysteine nebulization in pediatric patients [Utilisation du Fluimucil antibiotic 750 en aérosols chez le nourisson et l'enfant son efficacité d'expectoration]. Laboratoires Zambon, Paris 1982.
Leupold 1970 {published data only}
  • Leupold W von. Lung function in bronchial asthma during treatment with Mucosolvin [Die lungenfunktion bei asthma bronchiale unter der behandlung mit Mucosolvia]. Das Deutsche Gesundheitswesen 1970;25:1400-2.
Loscialpo Ramundo 1968 {published data only}
  • Loscialpo Ramundo D. On the use of the association of acetylcysteine and thiamphenicol glycinate in some pediatric pulmonary diseases [Sull'impiego associazone acetilcisteina-tiamfenicolo glicinato in alcune forme di patologia polmonare pediatrica]. Clinical Pediatrics 1968;50:43-56.
Mayaud 1980 {published data only}
  • Mayaud C, Lentschner C, Bouchoucha S, Marsac J. Thiamphenicol glycinate acetylcysteinate in the treatment of acute respiratory infections with mucostasis [L'acetylcysteinate de thiamphenicol glycinate dans le traitement des infections respiratoires aigues avec mucostase]. European Journal of Respiratory Diseases Supplement 1980;61(111):70-3.
Michael 1986 {published data only}
  • Michael P, Haase W. Treatment of acute and chronic bronchitis. Therapeutic experience with Pulmoclase [Behandlung akuter und chronischer bronchitis. Therapeutische erfahrungen mit Pulmoclase]. Therapiewoche 1986;36:4440-5.
Nigam 1981 {published data only}
  • Nigam BK. S-Carboxymethylcysteine (S-CMC) in bronchography technique. Indian Journal of Chest Diseases and Allied Sciences 1981;23:81-4.
Nikolic 1980 {published data only}
  • Nikolic P, Korac D. The influence of acetylcysteine on respiratory functions in children with recurrent bronchitis. European Journal of Respiratory Diseases Supplement 1980;61(111):141.
Olivieri 1979 {published data only}
  • Olivieri D, Pezza A, Polistina D, D'Agostino F. Clinical evaluation of a new pharmacological association in the therapy of acute and chronic bronchitis [Valutazione clinica di una nuova associazione farmacologica nella terapia delle broncopneumopatie acute e croniche]. Archivio Monaldi per la Tisiologia e le Malattie dell'Apparato Respiratorio 1979;34:29-41.
Plietz 1976 {published data only}
  • Plietz J. The treatment of bronchitic syndrome using Transbronchin in the practice. Zeitschrift für Allgemeinmedizin (Stuttgart) 1976;52:1832-4.
Poder 1982 {unpublished data only}
  • Poder G, Puskas J, Kelemen J, Gegesi Kiss A, Cserhati E. The effect of long term treatment with N-Acetylcysteine in infants with chronic obstructive bronchitis [Die Wirkung der Langzeitbehandlung mit N-Acetylcystein bei chronisch-obstruktiver Bronchitis im Sauglings- und Kleinkindalter]. Laboratoires Zambon (Pharmaceutical company), Paris 1982.
Ramenghi 1984 {published data only}
  • Ramenghi M, Sabayini G, Mengoni M. Combined antibiotic plus mucolytic treatment for recurrent bronchial diseases in infancy. Current Therapeutic Research 1984;36:664-7.
Ribeiro 1980 {published data only}
  • Ribeiro TM, Cunha LG, Santos M, Frenkiel S. Treatment of bronchial diseases in pediatrics. Results of the use of oral acetylcysteine in 80 cases. European Journal of Respiratory Diseases Supplement 1980;61(111):136-8.
Rudnik 1980 {published data only}
  • Rudnik J, Gawel J, Haluszka J, Kurzawa R, Mielnicka B, Majewska-Zalewska H, et al. Oral acetylcysteine treatment in children with chronic lung diseases. European Journal of Respiratory Diseases Supplement 1980;61(111):140.
Samsygina 1995 {published data only}
  • Samsygina G, Kazyukova T, Vykhristyuk O, Motina A, Tsaregorodtseva L, Dudina T. Acetylcysteine 100 in treatment of children with acute and chronic respiratory diseases: experience of use. Pediatriya (Moscow) 1995;1:76.
Santangelo 1985 {published data only}
  • Santangelo G, Lombardo S, Giannotti G. A combination of cefuroxime and N-acetyl-cysteine for the treatment of lower respiratory tract infections in children. International Journal of Clinical Pharmacology, Therapy, and Toxicology 1985;23:279-81.
Szekely 1980 {published data only}
  • Szekely E, Farkas E. Treatment of chronic bronchitis with oral acetylcysteine in children. European Journal of Respiratory Diseases Supplement 1980;61(111):142.
Trastotenojo 1984 {published data only}
  • Trastotenojo MS, Harsoyo N, Sachro AD, Soemantri AG, Said HW. Use of acetyl cysteine in respiratory tract disease in children. Paediatrica Indonesiana 1984;24:1-10.
Varricchio 2008 {published data only}
  • Varricchio A, Capasso M, Di Giocchino M, Ciprandi G. Inhaled thiamphenicol and acetylcysteine in children with acute bacterial rhinopharyngitis. International Journal of Immunopathology & Pharmacology 2008;21:625-9.
Volkl 1992 {published data only}
  • Volkl VKP, Schneider B. Treatment of airway diseases with N-acetylcystein. An open therapeutic observational study involving 2512 patients. Fortschritte der Medizin 1992;110:346-50.
Zens 1967 {published data only}
  • Zens VM. Clinical trial with a mucolytic agent, acetylcysteine, in children with bronchitis [Klinische Erfahrungen mit Acetylcystein, einer mukoltytiscen Substanz, bei der Bronchitis im Kindesalter]. Fortschritte der Medizin 1967;85:206-7.
Zuppi 1984 {published data only}
  • Zuppi LJ, Croce J. Effect of oral route acetylcysteine on the spirometric parameters in children with asthma or rhinitis [Efeito da acetilcisteina oral sobre os parametros espirometricos em criancas asmaticas ou com rinite]. Folha Médica 1984;89:305-8.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Anonymous 2000a
  • Anonymous. Acetylcysteine. In: McVoy GK editor(s). American Hospital Formulary System Drug Information. Bethesda, USA: American Society of Health-System Pharmacists Incorporation, 2000:472-4.
Anonymous 2000b
  • Anonymous. Acetylcysteine. Anonymous. Drug Facts and Comparisons 2000. 4th Edition. Saint Louis, USA: Facts and Comparisons, 2000:677-9.
Boluyt 2008
  • Boluyt N, Tjosvold L, Lefebvre C, Klassen TP, Offringa M. Usefulness of systematic review search strategies in finding child health systematic reviews in MEDLINE. Archives of Pediatrics and Adolescent Medicine 2008;162(2):111-6.
Bricks 1996
Bücheler 2002
  • Bücheler R, Schwab M, Mörike K, Kalchthaler B, Mohr H, Schröder H, et al. Off label prescribing to children in primary care in Germany: retrospective cohort study. BMJ 2002;324(7349):1311-2.
Cano Garcinuño 2013
  • Cano Garcinuño A,  Casares Alonso I, Rodríguez Barbero J, Pérez García I,  Blanco Quirós A. Prescription of systemic cold and cough drugs to children 0-13 years old. An unresolved problem. Anales de Pediatría 2013;78(1):43-50.
Cates 2003
  • Cates C. Visual Rx. Online NNT Calculator ( nntonline, 2003.
Cazzato 2001
Chalumeau 2000
  • Chalumeau M, Treluyer JM, Salanave B, Assathiany R, Cheron G, Crocheton N, et al. Off label and unlicensed drug use among French office based paediatricians. Archives of Disease in Childhood 2000;83(6):502-5.
Chang 2006
Collet 1991
  • Collet JP, Bossard N, Floret D, Gillet J, Honegger D, Boissel JP. Drug prescription in young children: results of a survey in France. European Journal of Clinical Pharmacology 1991;41:489-91.
Cumberland Pharmaceuticals 2008
  • Cumberland Pharmaceuticals. Acetadote(r) iv injection, acetylcysteine iv injection. Product information 2008.
Delgado-Rodriguez 2004
Duijvestijn 1997
  • Duijvestijn YC, Gerritsen J, Brand PL. Acetylcysteine in children with lung disorders prescribed by one-third of family physicians: no support in the literature. Nederlands Tijdschrift Voor Geneeskunde 1997;141:826-30.
Duijvestijn 1999
EMEA 2001
  • European Agency for the Evaluation of Medicinal Products. International conference on harmonisation of technical requirements for registration of pharmaceuticals for human use. Clinical investigation of medicinal products in the paediatric population (ICH Topic E11). 2001 (accessed 15 October 2007).
Halna 2005
  • Halna M, Leblond P, Aissi E, Dumonceaux A, Delepoulle F, El Kohen R, et al. Impact of the consensus conference on outpatient treatment of infant bronchiolitis. Presse Médicale 2005;34:277-81.
Harris 1967
Higgins 2003
Horen 2002
Horwitz 1980
Hughes 1994
Mallet 2011
  • Mallet P, Mourdi N, Dubus J-C, Bavoux F, Boyer-Gervoise M-J, Jean-Pastor M-J, et al. Respiratory paradoxical adverse drug reactions associated with acetylcysteine and carbocysteine systemic use in paediatric patients: a national survey. PLoS One 2011;6:e22792.
Medici 1979
  • Medici TC, Radielovic P. Effects of drugs on mucus glycoproteins and water in bronchial secretion. Journal of International Medical Research 1979;7(5):434-42.
Mourdi 2010
  • Mourdi N, Dubus JC, Bavoux F, Boyer-Gervoise M, Jean-Pastor MJ, Chalumeau M. Mucolytic drugs: towards a contraindication in infants. Archives de Pédiatrie 2010;17:735-6.
Naranjo 1981
Poole 2012
  • Poole P, Black PN, Cates CJ. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2012, Issue 8. [DOI: 10.1002/14651858.CD001287.pub4]
RevMan 2012
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Salas 1999
Sanz 1988
Sen 2011
Shields 2008
  • Shields MD, Bush A, Everard ML, McKenzie S, Primhak R, British Thoracic Society Cough Guideline Group. BTS guidelines: recommendations for the assessment and management of cough in children. Thorax 2008;63(Suppl 3):iii1-15.
Smith 2012
WHO 2007
  • WHO Child Growth Standards. Weight-for-age. 2013 (accessed 1 April 2013).
Wohl 1998
  • Wohl MEB. Developmental physiology of the respiratory system. In: Chernick V, Boat TF editor(s). Kendig’s Disorders of the Respiratory Tract in Children. Vol. 6th, Philadelphia, USA: WB Saunders Company, 1998.

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Duijvestijn 2009
  • Duijvestijn YCM, Mourdi N, Smucny J, Pons G, Chalumeau M. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochrane Database of Systematic Reviews 2009, Issue 1. [DOI: 10.1002/14651858.CD003124.pub3]