Acetylcysteine and carbocysteine are the most commonly prescribed mucolytic drugs. This systematic review aimed at assessing their efficacy and safety for treating acute upper and lower respiratory tract infections (ARTIs) in children without chronic broncho-pulmonary disease. A subgroup analysis among patients younger than two years was performed.
Forty-nine studies met the inclusion criteria. Six trials involving 497 participants were included to study efficacy and compared acetylcysteine or carbocysteine to placebo. Thirty-four studies including the previous six were eligible to study safety and involved 2064 paediatric patients.
The results of this review suggest actual but limited efficacy of acetylcysteine and carbocysteine and a good overall safety among children older than two years of age. However, the number of patients included was limited and the methodological quality was questionable. These results should also take into consideration the fact that acetylcysteine and carbocysteine are prescribed for self-limiting diseases (e.g., acute cough, bronchitis). Regarding children younger than two years, given concerns about safety, these drugs should only be used for ARTIs in the context of a randomised controlled trial.