Ali Banagozar Mohammadi
1, Maryam Zaare Nahandi
2, Negin Raad
1, Siroos Javani
1, Afshin Gharekhani
3*1 Medical Philosophy and History Research Center, Sina Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
2 Chronic Kidney Disease Research Center, Sina Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
3 Drug Applied Research Center and Department of Clinical Pharmacy (Pharmacotherapy), Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.
Abstract
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.