Mohamed Fahim, Sooriyarachchi M Roshini, Senarathna Lalith, Azhar Shifa, Sheriff M H Rezvi, Buckley Nick A, Eddleston Michael
South Asian Clinical Toxicology Research Collaboration, Department of Clinical Medicine, University of Colombo, Sri Lanka.
Clin Toxicol (Phila). 2007;45(2):132-5. doi: 10.1080/15563650600981145.
Although activated charcoal is widely used for the treatment of self-poisoning, its effectiveness is unknown. An important consideration is patient compliance since poor compliance will limit effectiveness. We aimed to describe compliance in a randomized controlled trial (RCT) performed in Sri Lanka, presuming that this would set the upper limits for compliance in routine clinical use.
1,103 patients randomized to single or multiple (six doses q4h) 50 g doses of superactivated charcoal were prospectively observed. Charcoal was given by study doctors who recorded the amount ingested and the amount of persuasion required for the patients to drink the charcoal.
559 patients were randomized to receive one dose and 544 to receive six doses. Data was available for 1,071 (97%) patients. Eighty-eight were unable to complete their course; 98 required a NG tube, leaving 885 patients that received the first dose by mouth. The mean estimated amount of the prescribed dose of charcoal taken orally as a single or first dose was 83% (95% C.I. 82-84%). For patients receiving multiple doses, this amount fell over the next five doses to 66% (63-69%). While only 3.2% of patients refused the first dose, 12.3% refused the sixth. Relatively less persuasion was required for patients ingesting the first or single dose; 38% of patients required intense persuasion by the sixth dose.
Compliance for a single dose of superactivated charcoal among trial patients was good. However, even in the ideal circumstances of a RCT, compliance decreased thereafter for patients taking more than one dose.
尽管活性炭被广泛用于治疗自我中毒，但其有效性尚不清楚。一个重要的考虑因素是患者的依从性，因为依从性差会限制疗效。我们旨在描述在斯里兰卡进行的一项随机对照试验（RCT）中的依从性情况，假定这将为常规临床使用中的依从性设定上限。
前瞻性观察了1103例被随机分配接受单次或多次（每4小时6剂）50克超级活性炭剂量的患者。活性炭由研究医生给予，他们记录摄入的量以及患者饮用活性炭所需的劝说量。
559例患者被随机分配接受一剂，544例接受六剂。1071例（97%）患者有数据。88例无法完成疗程；98例需要插入鼻胃管，剩下885例患者经口接受了第一剂。作为单次或第一剂口服的规定剂量活性炭的平均估计摄入量为83%（95%置信区间82 - 84%）。对于接受多剂的患者，在接下来的五剂中这个量降至66%（63 - 69%）。虽然只有3.2%的患者拒绝第一剂，但12.3%的患者拒绝第六剂。摄入第一剂或单次剂量的患者所需的劝说相对较少；到第六剂时，38%的患者需要强烈劝说。
试验患者中单次剂量超级活性炭的依从性良好。然而，即使在RCT的理想情况下，服用多剂的患者此后依从性仍会下降。
