Pharmacology, Therapeutics & Toxicology, Centre for Cardiovascular Science, and Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK.
Br J Clin Pharmacol. 2022 Dec;88(12):5070-5073. doi: 10.1111/bcp.15217. Epub 2022 Feb 7.
Organophosphorus (OP) insecticide poisoning causes respiratory failure due to acetylcholinesterase (AChE) inhibition. The AChE reactivating antidote pralidoxime was developed in the 1950s and was soon noted to benefit patients occupationally poisoned with the highly potent OP insecticide parathion. Routine use of pralidoxime and other oximes such as obidoxime then became widely recommended. However, nearly all severe cases of OP poisoning now result from self-poisoning with large volumes of less potent (WHO hazard class Ib and II) insecticides and co-formulated solvents. Unfortunately, oxime clinical trials have never shown benefit from their use for these patients, and some have shown that pralidoxime may be associated with harm, including increased mortality. Oximes should not be used routinely for the care of OP insecticide-poisoned patients until translational and clinical studies have identified a safe and effective oxime regimen and identified the patients who benefit.
有机磷（OP）杀虫剂中毒可导致乙酰胆碱酯酶（AChE）抑制引起的呼吸衰竭。AChE 重激活解毒剂解磷定于 20 世纪 50 年代开发，很快就被注意到对职业性接触高毒 OP 杀虫剂对硫磷中毒的患者有益。解磷定和其他肟类化合物（如双解磷）的常规使用随后被广泛推荐。然而，现在几乎所有 OP 中毒的严重病例都是由于大剂量接触低毒（世界卫生组织危害类别 Ib 和 II）杀虫剂和共同配制的溶剂而导致的自服中毒。不幸的是，肟类化合物的临床试验从未显示出对这些患者使用的益处，有些试验甚至表明解磷定可能与危害相关，包括死亡率增加。在转化和临床研究确定了安全有效的肟类药物方案并确定了受益的患者之前，肟类药物不应用于常规治疗 OP 杀虫剂中毒患者。
