Skip navigation
Skip navigation

Oximes for acute organophosphate pesticide poisoning (Review)

Buckley, Nicholas; Eddleston, Michael; Szinicz, Ladislaus

Description

BACKGROUND: Acute organophosphorus pesticide poisoning causes tens of thousands of deaths each year across the developing world. Standard treatment involves administration of intravenous atropine and oxime to counter acetylcholinesterase inhibition at the synapse. The usefulness of oximes, such as pralidoxime and obidoxime, has been challenged over the past 20 years by physicians in many parts of the world, who have failed to see benefit in their clinical practice. OBJECTIVES: To find the...[Show more]

dc.contributor.authorBuckley, Nicholas
dc.contributor.authorEddleston, Michael
dc.contributor.authorSzinicz, Ladislaus
dc.date.accessioned2015-12-13T22:59:11Z
dc.date.available2015-12-13T22:59:11Z
dc.identifier.issn1469-493X
dc.identifier.urihttp://hdl.handle.net/1885/83652
dc.description.abstractBACKGROUND: Acute organophosphorus pesticide poisoning causes tens of thousands of deaths each year across the developing world. Standard treatment involves administration of intravenous atropine and oxime to counter acetylcholinesterase inhibition at the synapse. The usefulness of oximes, such as pralidoxime and obidoxime, has been challenged over the past 20 years by physicians in many parts of the world, who have failed to see benefit in their clinical practice. OBJECTIVES: To find the clinical trial evidence for oximes producing clinical benefit in acute organophosphorus pesticide-poisoned patients. SEARCH STRATEGY: We carried out a systematic search to find randomised clinical trials (RCTs) of oximes in acute organophosphorus pesticide poisoning, using MEDLINE, EMBASE and Cochrane databases. All articles with the text words 'organophosphate' or 'oxime' together with 'poisoning' or 'overdose' were examined. (Search last updated November 2003.) SELECTION CRITERIA: Articles that could possibly be randomised clinical trials were retrieved to determine if this was the case. DATA COLLECTION AND ANALYSIS: The published methodology of the possible RCTs located is not clear. One was found in abstract form only and two other published trials also had many gaps in the published methodology. We have attempted to contact the principal authors of all three trials but have been unable to obtain further information. MAIN RESULTS: Two RCTs have been published, involving 182 patients treated with pralidoxime. These trials did not find benefit. However, the studies did not take into account a number of issues important for outcome and the methodology is unclear. Therefore, a generalised statement on effectiveness cannot be supported by the published results. In particular, characteristics at baseline were not evenly balanced, the dose of oxime was much lower than recommended in guidelines, there were substantial delays to treatment, and the type of organophosphate was not taken into account. The abstract of the third trial, a small possible RCT, is uninterpretable without further data. AUTHORS' CONCLUSIONS: Current evidence is insufficient to indicate whether oximes are harmful or beneficial in the management of acute organophosphorus pesticide poisoning. A much larger RCT is required to compare the World Health Organization recommended pralidoxime regimen (>30 mg/kg bolus followed by >8 mg/kg/hr infusion) with placebo. There are many theoretical and practical reasons why oximes may not be useful to patients with overwhelming self-poisoning. Such a study will need to be designed with pre-defined sub-group analysis to allow identification of patient sub-groups that may benefit from oximes.
dc.publisherThe Cochrane Library
dc.sourceCochrane Database of Systematic Reviews (CDSR)
dc.subjectKeywords: antidote; cholinesterase reactivator; organophosphorus compound; oxime; pesticide; pralidoxime; clinical trial; controlled clinical trial; human; intoxication; meta analysis; randomized controlled trial; review; Antidotes; Cholinesterase Reactivators; Hum
dc.titleOximes for acute organophosphate pesticide poisoning (Review)
dc.typeJournal article
local.description.notesImported from ARIES
local.description.refereedYes
local.identifier.citationvolume1
dc.date.issued2005
local.identifier.absfor111506 - Toxicology (incl. Clinical Toxicology)
local.identifier.ariespublicationMigratedxPub11935
local.type.statusPublished Version
local.contributor.affiliationBuckley, Nicholas, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationEddleston, Michael, University of Oxford
local.contributor.affiliationSzinicz, Ladislaus, Bundeswehr Institute of Pharmacology and Toxicology
local.bibliographicCitation.startpageCD005085
dc.date.updated2015-12-12T07:26:59Z
local.identifier.scopusID2-s2.0-18944364938
CollectionsANU Research Publications

Download

There are no files associated with this item.


Items in Open Research are protected by copyright, with all rights reserved, unless otherwise indicated.

Updated:  19 May 2020/ Responsible Officer:  University Librarian/ Page Contact:  Library Systems & Web Coordinator