| Background: Organophosphorus (OP) poisonings, a common source of pesticide
poisoning, are an important cause of morbidity and mortality in the developing countries.
Combination therapy with atropine and oxime is a common practice in the management of
OP poisoning. However, the additive benefit of using pralidoxime in addition to atropine
remains controversial. Due to inappropriate and widespread use of this relatively expensive
and low available antidote, we aimed to evaluate its usage in an Iranian teaching hospital.
Methods: Medical files of patients with pesticide poisoning who had been admitted to the
poisoning ward between September 2013 and September 2014 were reviewed. Patients
with definite diagnosis of OPs poisoning were selected to evaluate rational use of
pralidoxime in their treatment regimen. Data were collected using a checklist containing
demographic, clinical, and para clinical characteristics, as well as the type of pesticide
poisoning. Appropriateness of the pralidoxime therapy was determined based on clinical
practice guideline and endorsed by an attending medical toxicologist.
Results: 68.8% of patients had been poisoned with insecticides, 27.1% with aluminum
phosphide, 2.1% with herbicides, and 2% with rodenticides, respectively. OPs were
responsible for 43.8% of all poisoning. All patients with OPs poisoning received
pralidoxime after they had been admitted to emergency department, while only 55% of
them were eligible to receive pralidoxime. Moreover, pralidoxime had been administered
for 59% of patients with non-OPs poisoning, which all of them were clinically
inappropriate.
Conclusion: The use of pralidoxime in the northwest of Iran is not appropriate and thus, it
is highly recommended that a patient-tailored treatment guideline be provided and
implemented regionally. |