Comparison of efficacy of atropine versus atropine with pralidoxime in organophosphorus poisoning

Vikrama Raja, Simon A R, Udaykumar Padmaja


Background: Comparison of the efficacy of atropine alone against atropine with pralidoxime in the treatment of organophosphorus (OP) poisoning.

Methods: Forty two patients between the age group of 18 to 65 years, treated for OP poisoning and matched for baseline characteristics, were included in two groupsbased on treatment received as “Atropine only” or “Atropine plus pralidoxime(PAM)”.Main outcomes of the study were ICU stay, total hospital stay and mortality. ICU and hospital stay were compared using ‘t’ test while  mortality was compared using Fisher’s exact test.

Results: Total hospital stay was not significantly different between the treatment groups (95% CI of difference: -4.227, 0.784). Length of stay was also not significantly different between patients who received atropine plus PAM within 6 hours of consumption of poison and those who received 6 hours later (95% CI of difference: -4.154, 0.954; p value: 0.2).

Conclusion: Our data supports the use of only atropine over atropine plus PAM in patients with OP poisoning on account of no significant difference /reduction of hospital/ICU stay and mortality in the latter group. However, a study with a larger sample needs to be conducted, to be able to draw a definitive conclusion.


Organophosphorus (OP) poisoning, Pralidoxime (PAM), Peradeniya OP scale

Full Text:



Eddleston M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F, Senarathna L, Hittarage A, Azher S, Jeganathan K, Jayamanne S, Von Meyer L, Dawson AH, Sheriff MH, Buckley NA. Pralidoxime in acute organophosphorus insecticide poisoning--a randomised controlled trial. PLoS Med. 2009 Jun 30; 6(6):e1000104. doi: 10.1371/journal.pmed.

Eyer P. “The Role of Oximes in the Management of Organophosphorus Pesticide Poisoning.” Toxicological Reviews 2003;22:165-190.

Eddlestona M, Buckley NA, Eyer P, Dawson AH. “Management of acute organophosphorus pesticide poisoning.” The Lancet 2008;371:597–607.

Jeyaratnam J. “Acute pesticide poisoning: a major global health problem.” World Health Stat Q, 43 (1990), pp. 139–144.

Van der Hoek, Konradsen F, Athukorala K, Wanigadewa T. “Pesticide poisoning: a major health problem in Sri Lanka.” Soc Sci Med, 1998;46:495–504.

Eddleston M, Phillips MR. “Self poisoning with pesticides.” BMJ, 2004;328:42–44.

Gunnell D, Eddleston M, Phillips MR, Konradsen F. “The global distribution of fatal pesticide self-poisoning: Systematic review.” BMC Public Health 2007;7:357.

Chugh SN, Dushyant , Ram S, Arora B, Malhotra KC:. “Incidence & outcome of aluminium phosphide poisoning in a hospital study.” Indian J Med Res 1991,;94:232-235.

De Silva HE, Wijewickrema R, Senanayake N. “Does pralidoxime affect outcome of management in acute organophosphorus poisoning?” The Lancet 1992;339(8802):1136–1138.

Eddleston M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F. Pralidoxime in Acute Organophosphorus Insecticide Poisoning- A Randomised Controlled Trial. PLoS Med. 2009 Jun 30;6(6):e1000104. doi: 10.1371/journal.pmed.1000104.