A Randomized Controlled Clinical Trial to Compare the Efficacy of Pralidoxime When Given in Continuous Infusion Versus Intermittent Dose in Terms of Symptomatic Improvement Over a Given Time Scale
Article Sidebar
Main Article Content
Abstract
Background: Organophosphorus pesticide poisoning produces potentially fatal cholinergic toxicity, but the optimal pralidoxime maintenance regimen remains uncertain. Objective: To compare early clinical recovery following intermittent pralidoxime administration and continuous pralidoxime infusion in patients with acute organophosphorus poisoning. Methods: This parallel-group randomized controlled clinical trial included 104 patients treated at Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan, between 2024 and 2025. All patients received an initial 2-g intravenous pralidoxime dose. Group A received 1 g every six hours for 48 hours, whereas Group B received a continuous infusion of 8 mg/kg/hour for 48 hours. Clinical response was assessed at 24 and 48 hours. Categorical outcomes were compared using two-sided Fisher’s exact tests, with risk ratios and 95% confidence intervals calculated. Results: At 24 hours, clinical response occurred in 17 of 45 patients (37.8%) in Group A and 35 of 59 patients (59.3%) in Group B (RR, 1.57; 95% CI, 1.02–2.41; p=0.047). At 48 hours, response occurred in 40 patients (88.9%) and 58 patients (98.3%), respectively (RR, 1.11; 95% CI, 0.99–1.23; p=0.083). Treatment extension was required in 11.1% and 1.7% of patients, respectively (p=0.083). No deaths occurred. Conclusion: Continuous pralidoxime infusion was associated with faster clinical recovery at 24 hours, although later response differences were not statistically significant
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. World Health Organization. Clinical guidelines for the management of acute pesticide poisoning. Geneva: World Health Organization; 2008.
2. Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet. 2008;371(9612):597–607.
3. Balali-Mood M, Saber H. Recent advances in the treatment of organophosphorous poisonings. Iran J Med Sci. 2012;37(2):74–91.
4. Eyer P. The role of oximes in the management of organophosphorus pesticide poisoning. Toxicol Rev. 2003;22(3):165–190.
5. Pawar KS, Bhoite RR, Pillay CP, Chavan SC, Malshikare DS, Garad SG. Continuous pralidoxime infusion versus repeated bolus injection to treat organophosphorus pesticide poisoning: a randomised controlled trial. Lancet. 2006;368(9553):2136–2141.
6. Eddleston M, Eyer P, Worek F, Juszczak E, Alder N, Mohamed F, et al. Pralidoxime in acute organophosphorus insecticide poisoning: a randomised controlled trial. PLoS Med. 2009;6(6):e1000104.
7. Kharel H, Pokhrel NB, Ghimire R, Kharel Z. The efficacy of pralidoxime in the treatment of organophosphate poisoning in humans: a systematic review and meta-analysis of randomized trials. Cureus. 2020;12(3):e7174.
8. Afshari R, Farsi D, Mousavi SR, et al. Comparative study of continuous pralidoxime infusion versus intermittent dosing: application of high-performance liquid chromatography method on serum of organophosphate-poisoned patients. Asia Pac J Med Toxicol. 2013;2(3):85–90.
9. Kaur M, Kaur B, Singh A, et al. Comparison of continuous infusion versus repeated bolus of pralidoxime for the treatment of organophosphate pesticide poisoning. J Res Med Educ. 2019;2(1):1–6.
10. Jiang Y, Zhang Y, Wang L, et al. Emergency adjunctive therapy for organophosphate poisoning: a meta-analysis. Am J Emerg Med. 2025;78:45–52.
11. Attari MBA, Zaman T, Amjad A, Khan M, Waqar Z, Jabeen S. Comparative Analysis of Outcomes in Acute Organophosphate Poisoning With and Without N-acetyl Cysteine Intervention. Cureus. 2024.
12. Baek SH, Jo Y, Ahn S, Medina-Liabres K, Oh Y, Lee JB, et al. Risk of Overcorrection in Rapid Intermittent Bolus vs Slow Continuous Infusion Therapies of Hypertonic Saline for Patients With Symptomatic Hyponatremia: The SALSA Randomized Clinical Trial. JAMA Internal Medicine. 2020.
13. Baruah S, Das JK, Hossain I, Singh NB. A comparative study of atropine and atropine plus pralidoxime in the management of organo-phosphorous poisoning. International Journal of Advances in Medicine. 2023.
14. Bohnert S, Berg RMvd, Mikler J, Klaassen S, Joosen M. Comparative Pharmacokinetics of Three Oximes in a Guinea Pig Model and Efficacy of Combined Oxime Therapy. Toxicology Letters. 2020.
15. Dulhunty J, Brett SJ, Waele JDD, Rajbhandari D, Billot L, Cotta M, et al. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. Journal of the American Medical Association (JAMA). 2024.
16. Jung Y, Ryu D, Jeung K, Na J-Y, Lee D, Lee B, et al. Effect of pralidoxime on coronary perfusion pressure during cardiopulmonary resuscitation in a pig model. Clinical and Experimental Emergency Medicine. 2019.
17. Mamadjonov N, Jung Y, Jeung K, Lee H, Lee B, Youn C, et al. Pralidoxime improves the hemodynamics and survival of rats with peritonitis-induced sepsis. PLoS ONE. 2021.
18. Monti G, Bradic N, Marzaroli M, Konkayev A, Fominskiy E, Kotani Y, et al. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial. Journal of the American Medical Association (JAMA). 2023.
19. Ravi N, Reddy P, Ramana KV, Reddy C. Comparison of atropine and pralidoxime therapy with intravenous intralipid therapy in the management of organophosphorus compound poisoning at a tertiary care center. MRIMS journal of health sciences. 2025.
20. Warda AEA, Sarhan R, Al-Fishawy HS, Moharram A, Salem H. Continuous Versus Intermittent Linezolid Infusion for Critically Ill Patients with Hospital-Acquired and Ventilator-Associated Pneumonia: Efficacy and Safety Challenges. Pharmaceuticals. 2022.