The use of atropine in a nerve agent response with specific reference to children: are current guidelines too cautious?

Abstract

This review examines the potential use of nerve agents by a terrorist organisation against a civilian population, which has become an increasingly apparent threat in the UK. Present guidelines for the use of atropine, particularly in children, following such an event are unclear. No precise agreement exists on the most appropriate dose of atropine, or the frequency with which it should be administered. This uncertainty leaves children vulnerable as potentially life-saving treatment may be crucially delayed. Guidelines must be standardised to allow rapid antidotal delivery and maximise the potential for survivors. This review examines the issues currently surrounding the use of atropine in children following a nerve agent attack and propose strategies for treating exposed children.

Chemical-Biological Terrorism and Its Impact on Children

“…Baker 22 noted that adult doses of atropine are well tolerated, even in young children, and recommended the use of the atropine (0.5 or 2 mg) autoinjector for children younger than 1 year after nerve-agent exposures when weight dosing is impractical or not possible to control excessive bronchorrhea and to prevent respiratory failure. 22 In a 2009 review of research on atropine dosing, Sandilands et al 23 considered pharmacokinetic data to balance sufficient and timely dosing of atropine versus the risk of overdose; the authors recommended relatively large initial doses of atropine in children, who are relatively resistant to its adverse effects. Droste et al 21 used a pharmacokinetic model to analyze current CDC and US Army treatment protocols and found that in general, oxime therapy alone was ineffective in alleviating symptoms.…”

Progress with reducing mortality from organophosphorus insecticide poisoning

“…An intervention that stabilised patients in the first hour after poisoning has the potential to save many lives. Atropine auto-injectors are used widely by military and by adult and paediatric populations at risk of OP nerve agent exposure and have an excellent safety profile (30). Administration of atropine early in the community, via an auto-injector, to stabilise patients during transfer to hospital might save many lives.…”