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N-acetylcysteine (NAC), a glutathione precursor that augments intracellular antioxidant defenses, has shown otoprotective effects in three small randomized studies involving adults with end-stage renal failure receiving aminoglycosides, with pooled analysis suggesting a significant reduction in ototoxicity at 46 weeks ( in vitro studies have demonstrated that NAC may antagonize the antimicrobial efficacy of gentamicin and tobramycin, a concern that requires resolution before routine clinical adoption ( in vitro or in vivo ( Pharmacological modulation of intracellular trafficking has emerged as a preclinical research direction

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