Study of efficacy of pralidoxime in the management of organophosphorus poisoning

Abstract

Introduction: Organophosphorus (OP) compounds are organic compounds containing phosphorus. They are used primarily in pest control as an alternative to chlorinated hydrocarbons that persist in the environment. OP is the prime accused of pesticide poisoning and mortality especially in developing countries. Pralidoxime, usually as the chloride or iodide salts, belongs to a family of compounds called oximes that bind to organophosphate-inactivated acetylcholinesterase. Nowadays, OP poisoning treatments are including atropine and pralidoxime. While efficacy of atropine is demonstrated beyond hesitation, clinical knowledge with pralidoxime has led to widespread arguments about its efficacy in handling of OP poisoning. In this study, we compared the effectiveness of add-on pralidoxime therapy over therapy with atropine alone in OP poisoning. Objective: Study of efficacy of pralidoxime in the management of organophosphorus poisoning. Methods: OP poisoned patients (n=86) randomly divided to two groups and allocated to receive atropine (control group) or atropine plus pralidoxime (treatment group). The parameters which used for efficacy assessment were: a) mortality rate, b) duration of ventilator and intubation and, c) time to death. Results: Outcomes reported that the average intubation time/day in control and treatment groups were 12 ± 14.89 and 10 ± 7.16, respectively (p-value= 0.5). Additionally, average mechanical ventilation time/day in control and treatment groups reported 10.96 ± 13.97 and 10.57 ± 7.86, respectively (p-value= 0.5). Average time to death/day for control and treatment groups reported 8.75 ± 10.84 and 9.58 ± 9.60 respectively (p-value= 0.7). Conclusion: Add-on pralidoxime therapy did not compromise any significant improvement in the treatment of OP poisoning over atropine monotherapy, based on statistical analysis.