Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial.
BACKGROUND
The role of oximes for the treatment of organophosphorus pesticide poisoning has not been conclusively established. We aimed to assess the effectiveness of a constant pralidoxime infusion compared with repeated bolus doses to treat patients with moderately severe poisoning from organophosphorus pesticides.


METHODS
200 patients were recruited to our single-centre, open randomised controlled trial after moderately severe poisoning by anticholinesterase pesticide. All were given a 2 g loading dose of pralidoxime over 30 min. Patients were then randomly assigned to control and study groups. Controls were given a bolus dose of 1 g pralidoxime over 1 h every 4 h for 48 h. The study group had a constant infusion of 1 g over an hour every hour for 48 h. Thereafter, all patients were given 1 g every 4 h until they could be weaned from ventilators. Analysis was by intention to treat. Primary outcome measures were median atropine dose needed within 24 h, proportion of patients who needed intubation, and number of days on ventilation. The study is registered at http://www.clinicaltrials.gov with the identifier NCT00333944.


RESULTS
100 patients were assigned the high-dose regimen, and 100 the control regimen. There were no drop-outs. Patients receiving the high-dose pralidoxime regimen required less atropine during the first 24 h than controls (median 6 mg vs 30 mg; difference 24 mg [95% CI 24-26, p<0.0001]). 88 (88%) and 64 (64%) of controls and high-dose patients, respectively, needed intubation during admission to hospital (relative risk=0.72, 0.62-0.86, p=0.0001). Control patients required ventilatory support for longer (median 10 days vs 5 days; difference 5 days [5-6, p<0.0001]).


CONCLUSIONS
A high-dose regimen of pralidoxime, consisting of a constant infusion of 1 g/h for 48 h after a 2 g loading dose, reduces morbidity and mortality in moderately severe cases of acute organophosphorus-pesticide poisoning.
Pawar
Kirti S
KS
Giriraj Hospital and Intensive Care Unit, Baramati, Pune, Maharashtra, India. kirtispawar@yahoo.co.in
Bhoite
Ramesh R
RR
Pillay
Chandrakant P
CP
Chavan
Sujata C
SC
Malshikare
Dhananjay S
DS
Garad
Saraswati G
SG
D000328:Adult; D001794:Blood Pressure; D002801:Cholinesterase Reactivators / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007194:India; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D016015:Logistic Models; D008297:Male; D062025:Organophosphate Poisoning; D010575:Pesticides / Q000506:poisoning*; D011220:Pralidoxime Compounds / Q000008:administration & dosage / Q000627:therapeutic use*
D002801:Cholinesterase Reactivators; D010575:Pesticides; D011220:Pralidoxime Compounds; C028797:pralidoxime