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document
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 . FINDINGS 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 ] ) . INTERPRETATION 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 .
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Intervention_Pharmacological
pralidoxime
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Intervention_Pharmacological
pralidoxime
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Intervention_Pharmacological
pralidoxime
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Intervention_Control
bolus dose of 1 g pralidoxime over 1 h every 4 h for 48 h.
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Intervention_Pharmacological
constant infusion of 1 g over an hour every hour for 48 h.
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Intervention_Pharmacological
given 1 g every 4 h until they could be weaned from ventilators
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Outcome_Other
median atropine dose needed within 24 h , proportion of patients who needed intubation
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Outcome_Mental
number of days on ventilation
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Outcome_Physical
atropine
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Outcome_Other
intubation during admission to hospital
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Outcome_Physical
ventilatory support
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Outcome_Mortality
morbidity and mortality
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Participant_Condition
organophosphorus pesticide poisoning
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Participant_Sample-size
200 patients
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Participant_Condition
open randomised controlled trial after moderately severe poisoning by anticholinesterase pesticide
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Participant_Sample-size
100 patients
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Participant_Condition
pralidoxime regimen