N-Acetylcysteine and Other Sulfur-Donors as a Preventative and Adjunct Therapy for COVID-19

Table 1

Summary of a proposed therapeutic strategy to prevent and combat COVID-19.

Disease state	Sulfur-donor	Protease inhibitor	Comments
Prevention	Either NAC 1200 mg/day, carbocisteine 1500 mg/day, erdosteine 600 mg/day [184], or MSM 2 g/day [136].		Health care workers, frontline personnel, and those at high risk with comorbidities.
Mild disease	Double up the dosages indicated above.		Adequate dietary protein intake is important; they can add whey protein to the diet [21, 129, 134].
Moderate to severe symptoms	IV NAC upon hospital admission (100 mg/kg/day) for 7 to 10 days [160]	Doxycycline 100 mg qid 5 to 7 days [25, 57, 87]	Add L-cysteine to enteral feed [126, 127].
Severe to critically ill	Sodium thiosulfate—for 5 to 7 days and when symptoms subside, every 2^nd or 3^rd day.; Adults: 100 mL (25 g) of STS (rate of 5 mL/minute).; Paediatric 0–18 years: 1 mL/kg of body weight (250 mg/kg or approximately 30–40 mL/m^2 of BSA) (rate of 2.5 to 5 mL/minute) not to exceed 50 mL total dose of STS [185]; or IV NAC (150 mg/kg/day) for 7 to 10 days [160]	Doxycycline 100 mg bid 7 to 10 days [25, 57, 87]	STS might be a better option than NAC to modulate the cytokine storm in the critically ill.; Add L-cysteine to enteral feed [126, 127].; Give albumin [40, 57] or fresh frozen plasma [48, 49].; Avoid high tidal volume ventilation [3, 48, 69, 123].; Avoid both hypervolemia and hypernatremia [65, 68, 69].