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Objectives: The role of N-Acetyl cysteine (NAC) in Rodenticide poisoning hasn't been well established due to mixed results from various studies and lack of proper treatment guidelines. We aimed to evaluate the efficacy of NAC in the treatment of rodenticide poisoning. Methods: PubMed/MEDLINE, Scopus and the Cochrane Library were searched to identify the literature. Reference list of included studies and Clinicaltrials.gov were also searched for relevant studies. Only the Randomized controlled trials and observational studies assessing the efficacy of NAC in rodenticide poisoning published in English were included in our review. Cochrane Risk of Bias Assessment Tool and New Castle Ottawa scale was used for quality assessment. Two authors were independently involved in study selection, data extraction and quality assessment of the studies and disagreements were resolved by discussion or by consulting a third reviewer. Results: A total of 5 out of 2142 non-duplicate studies with 258 patients were considered for the analysis. Treatment with NAC was observed to have a better recovery rate (Odds Ratio [OR]: 2.32, 95% Confidence Interval [CI]: 1.32-4.09; 5 studies), lesser mortality (OR: 0.28, 95% CI: 0.15-0.53, 5 studies) and lesser intubation or ventilation rate (OR: 0.25, 95% CI: 0.11-0.60, 2 studies) when compared to the control group. However, there was no significant difference with respect to the hospitalization days (Mean Difference: 0.61, Standard deviation: -0.84 to 2.05, 3 studies). The quality of the included studies appeared to be moderate to high. Conclusions: Our findings indicate that NAC can be a promising agent in the management of rodenticide poisoning as it is showing a better survival and lower mortality rate when compared to the control group. Further high-quality studies are warranted.
Background: Treatment with N-Acetyl cysteine (NAC) in rodenticide poisoning has not been well established due to mixed study results and insufficient evidence. This review aimed to summarize the clinical benefits of NAC in the management of rodenticide poisoning. Method: This review follows the PICOS framework and the PRISMA guidelines. PubMed/MEDLINE, Scopus, and the Cochrane library were searched to identify the published literature from inception to September 2020, and a reference search was performed for additional relevant studies. The English language studies addressing the use of NAC in rodenticide poisoning were considered for the review. We considered all experimental and observational studies due to the insufficient number of interventional studies. Results: Ten studies (two RCTs, four observational, and four descriptive) out of 2,178 studies with 492 participants were considered for the review. Only six studies (two RCTs, one prospective, and three retrospective studies) reported recovery and mortality rates. Pooled results of RCTs (n=2) showed a significant recovery rate (Odds Ratio [OR]:3.97; 95% Confidence Interval [CI]:1.69-9.30), whereas summary estimates of prospective and retrospective studies recorded a non-significant effect. Meta-analysis of RCTs (OR: 0.25; 95% CI: 0.11-0.59; n=2) and retrospective studies (OR: 0.34; 95% CI: 0.15-0.78; n=3) showed a significant reduction in mortality, whereas pooled analysis of prospective studies recorded a non-significant effect. A significant reduction in intubation or ventilation (OR: 0.25; 95% CI: 0.11-0.60; 2 RCTs) and a non-significant (P=0.41) difference in duration of hospitalization was observed with NAC when compared to the non-NAC treated group. The quality of the included studies appeared to be moderate to high. Conclusion: Our findings indicate that NAC showed better survival and lower mortality rate when compared to a non-NAC treated group; hence NAC can be considered for the management of rodenticide poisoning.
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