Activated Charcoal in Resource Poor Settings: Reviewing the Evidence

Abstract

Background: Poisoning is unfortunately a common occurrence worldwide with relatively higher mortality in resource-poor settings, and oral activated charcoal (AC) is a standard therapy both for gastrointestinal decontamination as well as enhancement of elimination. AC is an inexpensive, widely available decontaminant with a favorable side effect profile. However, recent clinical trial results have called into question its benefit. This review was done to examine the recent clinical evidence evaluating standard AC decontamination in international resourcepoor settings. Methods: A review of the recent literature was conducted on both single dose activated charcoal, (SDAC) and multidose activated charcoal (MDAC) looking for the clinical evidence that supports its use. EMEDLINE Pubmed, Cochrane Databases, Clinicaltrials.gov, and Google Scholar were searched for published studies in the English language in the last 20 years using an exhaustive search methodology. Results: Out of all eligible studies published in the past 20 years, 64 total studies met criteria for inclusion. Of these, there were 4 MDAC trials (3 prospective, 1 retrospective) and 7 SDAC trials (5 prospective, 2 retrospective) with analyzable efficacy data. Of these, two studies showed mortality benefit, while most were underpowered to show a benefit. Subgroup analysis suggested greatest benefit for organophosphorus pesticides and cardiac glycosides. Conclusion: This review of the past two decades of literature evaluating the efficacy of AC in RPS found support for SDAC in undifferentiated overdose presenting in RPS. MDAC administration demonstrated benefit for selected poisonings, particularly cardiac glycosides and organophosphorus pesticides. In addition, adverse events associated with AC administration appear to be extremely rare.