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Title: | Improvement in survival after paraquat ingestion following introduction of a new formulation in Sri Lanka |
Authors: | Wilks, M.F. Fernando, R. Ariyananda, P.L. Eddleston, M. Berry, D.J. Tomenson, J.A. Buckley, N.A. Jayamanne, S. Gunnell, D. Dawson, A. |
Keywords: | Improvement in survival |
Issue Date: | 2008 |
Publisher: | Public Library of Science |
Citation: | PLoS Medicine.2008;5(2):e49 |
Abstract: | BACKGROUND: Pesticide ingestion is a common method of self-harm in the rural developing world. In an attempt to reduce the high case fatality seen with the herbicide paraquat, a novel formulation (INTEON) has been developed containing an increased emetic concentration, a purgative, and an alginate that forms a gel under the acid conditions of the stomach, potentially slowing the absorption of paraquat and giving the emetic more time to be effective. We compared the outcome of paraquat self-poisoning with the standard formulation against the new INTEON formulation following itsintroduction into Sri Lanka. METHODS AND FINDINGS: Clinical data were prospectively collected on 586 patients with paraquat ingestion presenting to nine large hospitals across Sri Lanka with survival to 3 mo as the primary outcome. The identity of the formulation ingested after October 2004 was confirmed by assay of blood or urine samples for a marker compound present in INTEON. The proportion of known survivors increased from 76/297 with the standardformulation to 103/289 with INTEON ingestion, and estimated 3-mo survival improved from 27.1% to 36.7% (difference 9.5%; 95% confidence interval [CI] 2.0%-17.1%; p = 0.002, log rank test). Cox proportional hazards regression analyses showed an approximately 2-fold reduction in toxicity for INTEON compared to standard formulation. A higher proportion of patients ingesting INTEON vomited within 15 min (38% with the originalformulation to 55% with INTEON, p < 0.001). Median survival time increased from 2.3 d (95% CI 1.2-3.4 d) with the standard formulation to 6.9 d (95% CI 3.3-10.7 d) with INTEON ingestion (p = 0.002, log rank test); however, in patients who did not survive there was a comparatively smaller increase in median time to death from 0.9 d (interquartile range [IQR] 0.5-3.4) to 1.5 d (IQR 0.5-5.5); p = 0.02. CONCLUSIONS: The survey has shown that INTEON technology significantly reduces the mortality of patients following paraquat ingestion and increases survival time, most likely by reducing absorption. Comment in : New formulation of paraquat: a step forward but in the wrong direction. [PLoS Med. 2008] |
Description: | Indexed in MEDLINE |
URI: | http://repository.kln.ac.lk/handle/123456789/11439 |
ISSN: | 1549-1277 (Print) 1549-1676 (Electronic) |
Appears in Collections: | Journal/Magazine Articles |
Files in This Item:
File | Description | Size | Format | |
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pmed.0050049.pdf | 276.12 kB | Adobe PDF | View/Open |
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