Antidotos

Clinical Toxicology (2009) 47, 77–80 Copyright © Informa UK, Ltd. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.1080/15563650701877366

ARTICLE
LCLT

Antidotes and their availability in South Africa
CHERYLYNN ANGELA WIUM and BEVEREY ANN HOFFMAN
Antidotes and their availability in South Africa

Tygerberg Poison Information Centre, Department Pharmacology, Cape Town, South AfricaIntroduction. The availability of antidotes is essential and often lifesaving in management of certain poisonings. Surveys conducted in a number of countries have demonstrated inadequate availability of antidotes. Since no similar studies have been published for South Africa, it was decided to investigate the local availability of antidotes. Methods. A questionnaire on the availability of antidoteswas sent to government and private hospital pharmacies. The list of commonly required antidotes and supportive agents was compiled from WHO guidelines. Results. The response rate was 94%. None of the responding hospitals stocked all of the antidotes on the list. Tertiary hospitals had the highest percentage (67%) of antidotes available. Discussion. Seven antidotes were not stocked by any of thehospitals, including digoxin-specific antibody fragments, dimercaprol, calcium disodium edetate, fomepizole, intravenous pyridoxine, silibinin, and succimer. Five of these are not registered as medicines in South Africa. Conclusions. Poison information centers should work with local drug coding committees to improve availability of important antidotes. Keywords Antidote; Availability; Survey; SouthAfrica

Introduction
Antidotes can be used to prevent the absorption of poisons, to enhance their elimination, and to counteract their effects. With modern resuscitation techniques and intensive care, some patients can recover fully without the use of antidotes (1). The use of certain antidotes may seem unnecessary and the majority of antidotes considered as adjuncts to supportive care (2). Incertain circumstances, however, antidotes may significantly reduce the need for medical interventions, in addition to shortening the length of therapy in a poisoned patient. This is especially important in rural and under-developed areas where specialized facilities are not readily available. In these circumstances, antidotes may be considered essential, life-saving pharmaceuticals (1,3). Surveysconducted by the World Health Organization (WHO), as well as studies done by independent groups (4–11), have demonstrated inadequate availability of antidotes. Since no such studies have been conducted for South Africa, it was decided to investigate the local availability of antidotes.

sent, in the form of a questionnaire (Table 1), to tertiary and secondary government hospital pharmacies, andprivate hospital pharmacies in the Western Cape province of South Africa. The list also was sent to all tertiary hospitals and secondary and private hospitals in the major cities in the other 8 provinces. Participants were asked to indicate which antiTable 1. The questionnaire sent to hospital pharmacies, listing antidotes and supportive agents Antidotes available at :___________ Activated charcoalAdrenaline Atropine Biperiden Calcium gluconate Carbocysteine Cholestyramine Dantrolene Desferrioxamine Dicobalt edetate Digoxin immune fab Dimercaprol Sodium calcium edetate Ethanol Flumazenil Fomepizole Glucagon Ipecacuanha Magnesium citrate Magnesium sulphate Methionine Methylene blue N-acetylcysteine Naloxone Nitrite/Na thiosulphate Noradrenaline Obidoxime Penicillamine PhentolaminePhenylephrine Polystyrene Sulphonate Na Prussian blue Pyridoxine (IV Solution) Silibinin Sorbitol Succimer Vitamin K1 Snake: antivenom Polyvalent Boomslang antivenom Scorpion venom antiserum Button spider venom antiserum

Materials and methods
A list of commonly required antidotes and supportive agents was compiled from WHO guidelines (2,12). This list was
Received 3 September 2007; accepted 19...