Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial
Background: Organophosphorus poisoning (OPP) is a major global public health problem. Pralidoxime has been used in a complimentary role to atropine for the management of OPP. World Health Organization (WHO) recommends use of pralidoxime but studies regarding its role have been inconclusive, ranging...
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| Format: | Article |
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Wolters Kluwer Medknow Publications
2015-01-01
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| Series: | Saudi Journal of Anaesthesia |
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| Online Access: | http://www.saudija.org/article.asp?issn=1658-354X;year=2015;volume=9;issue=1;spage=49;epage=54;aulast=Syed |
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| author | Sumaya Syed Showkat Ahmad Gurcoo Ayaz Khalid Farooqui Waqarul Nisa Khalid Sofi Tariq M Wani |
| author_facet | Sumaya Syed Showkat Ahmad Gurcoo Ayaz Khalid Farooqui Waqarul Nisa Khalid Sofi Tariq M Wani |
| author_sort | Sumaya Syed |
| collection | DOAJ |
| description | Background: Organophosphorus poisoning (OPP) is a major global public health problem. Pralidoxime has been used in a complimentary role to atropine for the management of OPP. World Health Organization (WHO) recommends use of pralidoxime but studies regarding its role have been inconclusive, ranging from being ineffective to harmful or beneficial. Materials and Methods: The present study was undertaken to evaluate the effectiveness of pralidoxime. Eddleston′s study was the most compelling factor for our study, as he showed worst outcomes using pralidoxime. Our practice of continuous use of pralidoxime was based on the WHO guidelines and the study by Pawar (2006), which showed better outcome with higher doses of pralidoxime. These conflicting results suggested that a re-evaluation of its use in our clinical practice was indicated. Results: There was no difference in mortality rates, hemodynamic parameters and atropine requirements between the AP and A groups. Mean duration of ventilation (3.6 ± 4.6 in AP group vs. 3.6 ± 4.4 in A group) and Intensive Care Unit stay (7.1 ± 5.4 in AP group vs. 6.8 ± 4.7 in A group) was comparable. Serum sodium concentrations showed a correlation with mortality, with lower concentrations associated with better outcomes. Conclusion: The study suggests that add-on WHO-recommended pralidoxime therapy does not provide any benefit over atropine monotherapy. Adding pralidoxime does not seem to be beneficial and at the same time does not result in increased mortality rates. Our practice changed after completion of this study, and it has proven to be of significant benefit to patients who had to bear the expense of treatment. |
| first_indexed | 2024-12-17T10:11:36Z |
| format | Article |
| id | doaj.art-6f9654319793492fbe5c1d6460456e1a |
| institution | Directory Open Access Journal |
| issn | 1658-354X |
| language | English |
| last_indexed | 2024-12-17T10:11:36Z |
| publishDate | 2015-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Anaesthesia |
| spelling | doaj.art-6f9654319793492fbe5c1d6460456e1a2022-12-21T21:53:00ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X2015-01-0191495410.4103/1658-354X.146306Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trialSumaya SyedShowkat Ahmad GurcooAyaz Khalid FarooquiWaqarul NisaKhalid SofiTariq M WaniBackground: Organophosphorus poisoning (OPP) is a major global public health problem. Pralidoxime has been used in a complimentary role to atropine for the management of OPP. World Health Organization (WHO) recommends use of pralidoxime but studies regarding its role have been inconclusive, ranging from being ineffective to harmful or beneficial. Materials and Methods: The present study was undertaken to evaluate the effectiveness of pralidoxime. Eddleston′s study was the most compelling factor for our study, as he showed worst outcomes using pralidoxime. Our practice of continuous use of pralidoxime was based on the WHO guidelines and the study by Pawar (2006), which showed better outcome with higher doses of pralidoxime. These conflicting results suggested that a re-evaluation of its use in our clinical practice was indicated. Results: There was no difference in mortality rates, hemodynamic parameters and atropine requirements between the AP and A groups. Mean duration of ventilation (3.6 ± 4.6 in AP group vs. 3.6 ± 4.4 in A group) and Intensive Care Unit stay (7.1 ± 5.4 in AP group vs. 6.8 ± 4.7 in A group) was comparable. Serum sodium concentrations showed a correlation with mortality, with lower concentrations associated with better outcomes. Conclusion: The study suggests that add-on WHO-recommended pralidoxime therapy does not provide any benefit over atropine monotherapy. Adding pralidoxime does not seem to be beneficial and at the same time does not result in increased mortality rates. Our practice changed after completion of this study, and it has proven to be of significant benefit to patients who had to bear the expense of treatment.http://www.saudija.org/article.asp?issn=1658-354X;year=2015;volume=9;issue=1;spage=49;epage=54;aulast=SyedAcetyl-cholinesteraseatropineorganophosphorous poisoningpralidoximepseudo-cholinesteraseventilation |
| spellingShingle | Sumaya Syed Showkat Ahmad Gurcoo Ayaz Khalid Farooqui Waqarul Nisa Khalid Sofi Tariq M Wani Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial Saudi Journal of Anaesthesia Acetyl-cholinesterase atropine organophosphorous poisoning pralidoxime pseudo-cholinesterase ventilation |
| title | Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial |
| title_full | Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial |
| title_fullStr | Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial |
| title_full_unstemmed | Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial |
| title_short | Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial |
| title_sort | is the world health organization recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning a randomized double blinded and placebo controlled trial |
| topic | Acetyl-cholinesterase atropine organophosphorous poisoning pralidoxime pseudo-cholinesterase ventilation |
| url | http://www.saudija.org/article.asp?issn=1658-354X;year=2015;volume=9;issue=1;spage=49;epage=54;aulast=Syed |
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