Pralidoxime in Acute Organophosphorus Insecticide Poisoning—A Randomised Controlled Trial

Abstract

In a randomized controlled trial of individuals who had taken organophosphorus insecticides, Michael Eddleston and colleagues find that there is no evidence that the addition of the antidote pralidoxime offers benefit over atropine and supportive care.

A Case Control Study of Intravenous Magnesium Sulphate in Treatment of Acute Organophosphate Poisoning

“…Thus, the goal of this case control study was to elaborate the value of magnesium sulphate (MgSO4) in the management and outcome of OP insecticide poisoning. (16) Magnesium inhibits acetylcholine release probably through blocking calcium channel. It has several attractive additional therapeutic properties including muscle relaxation, which could control spasms and cardiovascular effects (e.g.…”

Progress in Antidotes (Acetylcholinesterase Reactivators) Against Organophosphorus Pesticides

“…Since 1950's, this drug was introduced globally and it remains in the standard treatment of OPP intoxication in many countries. However, the pralidoxime reactivation of OPP inhibited AChE was found to be debatable for many reason (Eddleston 2009). Whilst the reactivator concentration attainable in human blood after i.m.…”

“…OPP type, OPP dose, delay before treatment, pralidoxime dosage (Buckley 2005, Eddleston 2008). Thus, the randomised controlled trial was performed (Eddleston 2009). Though patients with relatively low-dose occupational poisoning by diethyl OPPs showed clinically improvement after low-dose pralidoxime administration, the use of WHO recommended high pralidoxime doses did not improved survival of the OPP self-poisoned patients.…”

Non-muscarinic Therapeutic Targets for Acute Organophosphorus Poisoning

“…However, 2-PAM has a limited window of effectiveness and cannot regenerate functional AChE once the alkyl chains of the OP are removed by aging. Furthermore, a recent randomized controlled trial of 2-PAM showed a trend toward harm with 2-PAM when compared to saline placebo [11]. Efficacy of current antidotes is therefore severely limited and new approaches to treatment for OP poisoning, such as pharmacologically targeting the NMJ, could lead to improved outcomes.…”