CON: Oximes should not be used routinely in organophosphorus insecticide poisoning.

Abstract

Organophosphorus (OP) insecticide poisoning causes respiratory failure due to acetylcholinesterase (AChE) inhibition. The AChE reactivating antidote pralidoxime was developed in the 1950s and was soon noted to benefit patients occupationally poisoned with the highly potent OP insecticide parathion. Routine use of pralidoxime and other oximes such as obidoxime then became widely recommended. However, nearly all severe cases of OP poisoning now result from self-poisoning with large volumes of less potent (WHO hazard class Ib and II) insecticides and co-formulated solvents. Unfortunately, oxime clinical trials have never shown benefit from their use for these patients, and some have shown that pralidoxime may be associated with harm, including increased mortality. Oximes should not be used routinely for the care of OP insecticide-poisoned patients until translational and clinical studies have identified a safe and effective oxime regimen and identified the patients who benefit.

• Authors: Michael Eddleston
• Journal: British journal of clinical pharmacology (Br J Clin Pharmacol) Vol. 88 Issue 12 Pg. 5070-5073 (12 2022) ISSN: 1365-2125 [Electronic] England
• PMID: 34989015 (Publication Type: Journal Article)
• Copyright: © 2022 British Pharmacological Society.

Chemical References

• pralidoxime
• Insecticides
• Oximes
• Acetylcholinesterase
• Organophosphorus Compounds
• Cholinesterase Inhibitors

Topics

• Humans
• Insecticides (therapeutic use)
• Oximes (therapeutic use)
• Acetylcholinesterase (therapeutic use)
• Organophosphorus Compounds (therapeutic use)
• Organophosphate Poisoning (drug therapy)
• Cholinesterase Inhibitors (therapeutic use)
• Poisoning