Compliance for single and multiple dose regimens of superactivated charcoal: a prospective study of patients in a clinical trial.
BACKGROUND
Although activated charcoal is widely used for the treatment of self-poisoning, its effectiveness is unknown. An important consideration is patient compliance since poor compliance will limit effectiveness. We aimed to describe compliance in a randomized controlled trial (RCT) performed in Sri Lanka, presuming that this would set the upper limits for compliance in routine clinical use.


METHODS
1,103 patients randomized to single or multiple (six doses q4h) 50 g doses of superactivated charcoal were prospectively observed. Charcoal was given by study doctors who recorded the amount ingested and the amount of persuasion required for the patients to drink the charcoal.


RESULTS
559 patients were randomized to receive one dose and 544 to receive six doses. Data was available for 1,071 (97%) patients. Eighty-eight were unable to complete their course; 98 required a NG tube, leaving 885 patients that received the first dose by mouth. The mean estimated amount of the prescribed dose of charcoal taken orally as a single or first dose was 83% (95% C.I. 82-84%). For patients receiving multiple doses, this amount fell over the next five doses to 66% (63-69%). While only 3.2% of patients refused the first dose, 12.3% refused the sixth. Relatively less persuasion was required for patients ingesting the first or single dose; 38% of patients required intense persuasion by the sixth dose.


CONCLUSIONS
Compliance for a single dose of superactivated charcoal among trial patients was good. However, even in the ideal circumstances of a RCT, compliance decreased thereafter for patients taking more than one dose.
Mohamed
Fahim
F
South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.
Sooriyarachchi
M Roshini
MR
Senarathna
Lalith
L
Azhar
Shifa
S
Sheriff
M H Rezvi
MH
Buckley
Nick A
NA
Eddleston
Michael
M
D002606:Charcoal / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D007441:Intubation, Gastrointestinal; D010349:Patient Compliance; D011041:Poisoning / Q000188:drug therapy*; D011446:Prospective Studies; D013188:Sri Lanka
D002606:Charcoal