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• W4247060491 abstract "Kirti Pawar and colleagues1Pawar KS Bhoite RR Pillay CP Chavan S Malshikare DS Garad MS Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial.Lancet. 2006; 368: 2136-2141Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar report that high-dose pralidoxime infusion in patients with organophosphorus pesticide poisoning is associated with a positive clinical outcome. This surprising conclusion contradicts previously published evidence.2Buckley NA Eddleston M Szinicz L Oximes for acute organophosphate pesticide poisoning.Cochrane Database Syst Rev. 2005; 1 (CD005085.)Google ScholarFirst, the case fatality rates in the study group and the control group (1% vs 8%) are much lower than in a systematic review of two clinical trials (182 people): 22% versus 14% and 29% versus 5%, respectively.2Buckley NA Eddleston M Szinicz L Oximes for acute organophosphate pesticide poisoning.Cochrane Database Syst Rev. 2005; 1 (CD005085.)Google Scholar Also, the median atropine dose needed to dry the tracheobronchial tree in the study and control groups (6 mg and 30 mg, respectively) within 24 h of admission was much smaller than that in a previous trial.3Cherian AM Peter JV Johnson S et al.Effectiveness of oximes (PAM- Pralidoxime) in the treatment of organophosphorus poisoning (OPP) a randomised, double blind placebo controlled clinical trial.J Assoc Physicians India. 1997; 45: 22-24Google Scholar Of note, although Pawar and colleagues enrolled only mildly poisoned patients, they intubated a much larger proportion of them (study group, 64%; control group, 88%) than the authors of a previous study (23%).4Eddleston M Eyer P Worek F et al.Differences between organophosphorus insecticides in human self-poisoning: a prospective cohort study.Lancet. 2005; 366: 1452-1459Summary Full Text Full Text PDF PubMed Scopus (274) Google Scholar The report does not explain these contradictions.Second, the study patients were asked to buy pralidoxime at a cost of about US$400 for the first 48 h, an amount “far beyond the capacity of most patients in rural Asia” in Pawar and colleagues' words. We believe that study patients should not pay for trial medications and are surprised that the local ethics committee ignored this fact.Finally, because there was no blinding, as the trial advanced and the data accrued, Pawar and colleagues were aware that the study group was doing significantly better than the control group (one death vs eight deaths). Did Pawar and colleagues share this fact with the participants who were enrolled late in the study? Was it ethical to continue the trial despite this observation?We declare that we have no conflict of interest. Kirti Pawar and colleagues1Pawar KS Bhoite RR Pillay CP Chavan S Malshikare DS Garad MS Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial.Lancet. 2006; 368: 2136-2141Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar report that high-dose pralidoxime infusion in patients with organophosphorus pesticide poisoning is associated with a positive clinical outcome. This surprising conclusion contradicts previously published evidence.2Buckley NA Eddleston M Szinicz L Oximes for acute organophosphate pesticide poisoning.Cochrane Database Syst Rev. 2005; 1 (CD005085.)Google Scholar First, the case fatality rates in the study group and the control group (1% vs 8%) are much lower than in a systematic review of two clinical trials (182 people): 22% versus 14% and 29% versus 5%, respectively.2Buckley NA Eddleston M Szinicz L Oximes for acute organophosphate pesticide poisoning.Cochrane Database Syst Rev. 2005; 1 (CD005085.)Google Scholar Also, the median atropine dose needed to dry the tracheobronchial tree in the study and control groups (6 mg and 30 mg, respectively) within 24 h of admission was much smaller than that in a previous trial.3Cherian AM Peter JV Johnson S et al.Effectiveness of oximes (PAM- Pralidoxime) in the treatment of organophosphorus poisoning (OPP) a randomised, double blind placebo controlled clinical trial.J Assoc Physicians India. 1997; 45: 22-24Google Scholar Of note, although Pawar and colleagues enrolled only mildly poisoned patients, they intubated a much larger proportion of them (study group, 64%; control group, 88%) than the authors of a previous study (23%).4Eddleston M Eyer P Worek F et al.Differences between organophosphorus insecticides in human self-poisoning: a prospective cohort study.Lancet. 2005; 366: 1452-1459Summary Full Text Full Text PDF PubMed Scopus (274) Google Scholar The report does not explain these contradictions. Second, the study patients were asked to buy pralidoxime at a cost of about US$400 for the first 48 h, an amount “far beyond the capacity of most patients in rural Asia” in Pawar and colleagues' words. We believe that study patients should not pay for trial medications and are surprised that the local ethics committee ignored this fact. Finally, because there was no blinding, as the trial advanced and the data accrued, Pawar and colleagues were aware that the study group was doing significantly better than the control group (one death vs eight deaths). Did Pawar and colleagues share this fact with the participants who were enrolled late in the study? Was it ethical to continue the trial despite this observation? We declare that we have no conflict of interest. High-dose pralidoxime for organophosphorus poisoning – Authors' replyThe authors of three letters concur with our conclusions that the cost of treatment with the high dose of pralidoxime is prohibitive and that all efforts should be made to reduce the cost of the antidote. In the context of the present study, we made every effort to write off the cost of treatment, including hospital charges and doctors' fees, in order to offset the high cost of pralidoxime. Full-Text PDF" @default.
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• W4247060491 title "High-dose pralidoxime for organophosphorus poisoning" @default.
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