Citation

Bateman DN, Carroll R, Pettie J, Yamamoto T, Elamin ME, Peart L, Dow M, Coyle J, Cranfield KR, Hook C, Sandilands EA, Veiriaiah A, Webb DJ, Gray A, Dargan PI, Wood DM, Thomas SHL, Dear JW, Eddleston M. Br. J. Clin. Pharmacol. 2014; 78(3): 610-618.

Affiliation

NPIS Edinburgh & Royal Infirmary of Edinburgh, Edinburgh, UK.

Copyright

(Copyright © 2014, John Wiley and Sons)

DOI

10.1111/bcp.12362

PMID

24666324

Abstract

AIMS: In September 2012 the UK's Commission on Human Medicines (CHM) recommended changes in management of paracetamol poisoning: use of a single '100mg/L' nomogram treatment line; ceasing risk assessment; treating all staggered/uncertain ingestions; increasing the duration of the initial acetylcysteine (NAC) infusion from 15 to 60min. We evaluated the effect of this on presentation, admission, treatment, adverse reactions, and costs of paracetamol poisoning.

METHODS: Prospectively collected data from adult patients presenting to 3 large UK hospitals from 3 Sept 2011 to 3 Sept 2013 (year before and after change). Infusion duration effect on vomiting and anaphylactoid reactions was examined in one centre. A cost analysis from an NHS perspective was performed for 90,000 patients/annum with paracetamol overdose.

RESULTS: There were increases in the numbers:- presenting to hospital (before 1703, after 1854; increase 8.9%[95%CI 1.9-16.2] p=0.011); admitted (1060/1703 [62.2%] vs 1285/1854 [69.3%]; increase: 7.1% [4.0-10.2], p<0.001); and proportion treated (626/1703 [36.8%] vs 926/1854 [50.0%]; increase: 13.2% [10.0-16.4] p<0.001). Increasing initial NAC infusion did not change the proportion of treated patients developing adverse reactions (15min 87/323[26.9%], 60min 145/514[28.2%]; increase: 1.3%[-4.9-7.5] p=0.682). Across the UK the estimated cost impact is £8.3M (6.4M to 10.2M) annually, with a cost-per-life saved of £17.4 M (95% CI 13.4 to 21.5 M).

CONCLUSIONS: The changes introduced by the CHM in September 2012 have increased the numbers of patients admitted to hospital and treated with acetylcysteine without reducing adverse reactions. A safety and cost-benefit review of the CHM guidance is warranted, including novel treatment protocols and biomarkers in assessment of poisoning.

Language: en