Open-label randomized controlled study comparing continuous infusion versus intermittent bolus dose of atropine with or without pralidoxime in the treatment of organophosphorus poisoning in a teaching hospital

Abstract

Background: Severe organophosphorus (OPC) poisoning is one of the serious problems in developing world, taking great toll on life. Though Atropine is used as an antidote, there are no clear guidelines. We conducted an open label randomized controlled clinical study to compare the efficacy of continuous infusion of atropine to that of intermittent bolus dose in the treatment of OPC poisoning. Methods and Material: Patients aged above 12 years with clinical evidence of OPC poisoning were studied. Both the groups received initial bolus of 1to3 mg of atropine. Then, Group-A received intermittent bolus and group-B, continuous infusion, until adequately atropinized. Results: Out of 743 patients (group-A: 356 and group-B: 387), females were 54%. 83% had suicidal intent. Mean atropine dose was 126.6mg in group-A and 78mg in group-B (P < 0.0001) . 21.07% (group-A) and 12.92% (group-B) developed intermediate syndrome (P = 0.003) , mortality was 27.25%(97) in group-A v/s 13%(50) in group-B (P < 0.0001) . Ventilator support needed in 36%(group-A) against 17% in group-B (P < 0.0001) and duration of ventilation was 1.5 days lesser in group B (P < 0.0001) . 23.03% had atropine toxicity in group-A as compared to 8% in group-B (P < 0.0001) . Hospital stay was 1.67 (P < 0.0001) days shorter for group-B. Conclusion: Continuous atropine infusion should be standard of care in treating OPC poisoning.

Keywords

• Atropine
• continuous versus intermittent
• organophosphorus
• poisoning