title: Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial.
abstract: BACKGROUND
  Organophosphorus poisoning (OPP) is a major global public health problem. Pralidoxime has been used in a complimentary role to atropine for the management of OPP. World Health Organization (WHO) recommends use of pralidoxime but studies regarding its role have been inconclusive, ranging from being ineffective to harmful or beneficial.
  
  
  METHODS
  The present study was undertaken to evaluate the effectiveness of pralidoxime. Eddleston's study was the most compelling factor for our study, as he showed worst outcomes using pralidoxime. Our practice of continuous use of pralidoxime was based on the WHO guidelines and the study by Pawar (2006), which showed better outcome with higher doses of pralidoxime. These conflicting results suggested that a re-evaluation of its use in our clinical practice was indicated.
  
  
  RESULTS
  There was no difference in mortality rates, hemodynamic parameters and atropine requirements between the AP and A groups. Mean duration of ventilation (3.6 ± 4.6 in AP group vs. 3.6 ± 4.4 in A group) and Intensive Care Unit stay (7.1 ± 5.4 in AP group vs. 6.8 ± 4.7 in A group) was comparable. Serum sodium concentrations showed a correlation with mortality, with lower concentrations associated with better outcomes.
  
  
  CONCLUSIONS
  The study suggests that add-on WHO-recommended pralidoxime therapy does not provide any benefit over atropine monotherapy. Adding pralidoxime does not seem to be beneficial and at the same time does not result in increased mortality rates. Our practice changed after completion of this study, and it has proven to be of significant benefit to patients who had to bear the expense of treatment.
authors.affiliation: Department of Anesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India.
authors.forename: Sumaya
authors.initials: S
authors.lastname: Syed
authors.affiliation: Department of Anesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India.
authors.forename: Showkat Ahmad
authors.initials: SA
authors.lastname: Gurcoo
authors.affiliation: Department of Anesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India.
authors.forename: Ayaz Khalid
authors.initials: AK
authors.lastname: Farooqui
authors.affiliation: Department of Anesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India.
authors.forename: Waqarul
authors.initials: W
authors.lastname: Nisa
authors.affiliation: Department of Anesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India.
authors.forename: Khalid
authors.initials: K
authors.lastname: Sofi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
authors.forename: Tariq M
authors.initials: TM
authors.lastname: Wani
keywords: Acetyl-cholinesterase; atropine; organophosphorous poisoning; pralidoxime; pseudo-cholinesterase; ventilation