Pralidoxime in the treatment of carbamate intoxication.

The use of oxime reactivators of inhibited cholinesterase enzymes in poisoning by carbamate compounds has received mixed reviews in the medical literature. Data are limited and inconsistent on the possible role oxime reactivators might have in carbamate intoxication. Based on existing experience, atropine remains the treatment of choice and pralidoxime (2-PAM) is not recommended except in cases where atropine has first been proven inadequate, in serious mixed poisonings with both carbamate and organophosphorus compounds, or in serious poisonings by unidentified cholinesterase inhibitors.