High doses of the drug pralidoxime reduces illness and death in people who have intentionally ingested organophosphorus pesticides – a common form of self-poisoning in rural India, according to a study in this week’s issue of The Lancet.
The standard treatment for poisoning with organophosphorus pesticide is intravenous atropine and oximes, such as pralidoxime. A dose of 1g oximes every 4-6 hours is the standard regimen in Asian district hospitals. However, neither the effectiveness of oximes nor the optimum dose schedule for such treatments has been established.
In this study Kirti Pawar (Giriraj Hospital & Intensive Care Unit, Pawar, Maharashtra, India) and colleagues assessed the effect of high doses of pralidoxime on patient outcome. The investigators randomly assigned 200 patients with moderately severe organophosphorus pesticide poisoning to constant infusion of 1g of pralidoxime over an hour every hour for 48 hours or a 1g dose over 1 hour every 4 hours for 48 hours. They found that those on the higher dose pralidoxime spent less time on ventilation support (5 vs. 10 days) and had fewer deaths when compared with the control group (1 vs. 8 deaths).
Dr Pawar concludes: “…although a small study, we report pronounced benefits from a high dose infusion of pralidoxime with moderately severe poisoning… Unfortunately, pralidoxime is expensive—our high-dose regimen costs around US$400 for the first 48 h, which is far beyond the capacity of most patients in rural Asia. More affordable sources of pralidoxime will be needed to relieve the heavy burden of organophosphorus poisoning on both rural Asian communities and their health care systems.”
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Contact: Dr Kirti Satish Pawar, Giriraj Hospital & Intensive Care Unit, Indapur Road, Baramati, Pune District, Maharashtra, 413 102, India. T) 91 2112 226 088 firstname.lastname@example.org.
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