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n CME : Your SA Journal of CPD - Role of oximes in organophosphate poisoning - a case report : clinical pharmacology
- Supportive therapy, including assisted ventilation, is the mainstay of managing organophosphate pesticide poisoning.
- Atropine is the cornerstone of medical therapy.
- The role of oximes has been controversial for many years with insufficient evidence for benefit or harm. However, a recent RCT showed that higher doses of pralidoxime resulted in better outcomes than standard doses. Early administration of the oximes (within 2 hours) is therefore recommended in patients with major toxicity.
- In South Africa, an IV bolus of 250 mg obidoxime, followed by an infusion of 750 mg over 24 hours is now recommended. Although this is off-label, i.e. different dosing instruction from the package insert, this recommendation is consistent with WHO guidelines and the recent RCT showing a favourable response to high-dose early therapy.
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