Impact of reducing the threshold for acetylcysteine treatment in acute paracetamol poisoning: The recent United Kingdom experience

Bateman, D. N.; Dear, James W.; Carroll, Robert; Pettie, Janice; Yamamoto, Takahiro; Elamin, Muhammad E. M. O.; Peart, Lucy; Dow, Margaret; Coyle, J. Terrence; Gray, Alasdair; Dargan, Paul I.; Wood, David M.; Eddleston, Michael; Thomas, Simon H.L.

doi:10.3109/15563650.2014.954125

Cited by 20 publications

(10 citation statements)

References 9 publications

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“…This “150 line” on the Rumack-Matthews nomogram is a level imposed by FDA to ensure as many patients as possible are treated without increasing the risk of overtreatment and the attendant costs of therapy. [68, 70] In other nations, such as the U.K., the threshold plasma concentration was lowered to 100 mg/L in 2012 [71] This change in national guidelines resulted in an increased proportion of patients being admitted and treated with NAC, most of whom presented with concentrations between 100 and 149mg/L. However, the change was not associated with any increase in adverse reactions to NAC.…”

Section: Specific Antidotes To Treat Dilimentioning

confidence: 99%

“…However, the change was not associated with any increase in adverse reactions to NAC. [71] In Hong Kong, Chan et al[70] reported that only 21% of 893 patients presented with an overdose concentration above the 150 treatment line threshold, with 12.5% having serum levels between 100 and 150ug, and 66.5% were below the 100ug treatment line. They cautioned that while lowering the treatment line to 100ug would cut the NAC failure rate from 0.45% to 0.22%, it needs to be balanced against a higher incidence of anaphylactoid reactions and increased costs.…”

Section: Specific Antidotes To Treat Dilimentioning

confidence: 99%

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Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review

Stine¹,

Lewis²

2015

Expert Review of Gastroenterology & Hepatology

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While the pace of discovery of new agents, mechanisms and risk factors involved in drug-induced liver injury (DILI) remains brisk, advances in the treatment of acute DILI seems slow by comparison. In general, the key to treating suspected DILI is to stop using the drug prior to developing irreversible liver failure. However, predicting when to stop is an inexact science, and commonly used ALT monitoring is an ineffective strategy outside of clinical trials. The only specific antidote for acute DILI remains N-acetylcysteine (NAC) for acetaminophen poisoning, although NAC is proving to be beneficial in some cases of non-acetaminophen DILI in adults. Corticosteroids can be effective for DILI associated with autoimmune or systemic hypersensitivity features. Ursodeoxycholic acid, silymarin and glycyrrhizin have been used to treat DILI for decades, but success remains anecdotal. Bile acid washout regimens using cholestyramine appear to be more evidenced based, in particular for lefluonomide toxicity. For drug-induced acute liver failure, the use of liver support systems is still investigational in the United States and emergency liver transplant remains limited by its availability. Primary prevention appears to be the key to avoiding DILI and the need for acute treatment. Pharmacogenomics, including HLA genotyping and the discovery of specific DILI biomarkers offers significant promise for the future. This article describes and summarizes the numerous and diverse treatment and prevention modalities that are currently available to manage DILI.

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Section: Specific Antidotes To Treat Dilimentioning

confidence: 99%

Section: Specific Antidotes To Treat Dilimentioning

confidence: 99%

Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review

Stine¹,

Lewis²

2015

Expert Review of Gastroenterology & Hepatology

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“…The UK position differs from international guidance (the United States and Australia use higher ingestion thresholds to trigger treatment 17 18 ) and may need revisiting because a substantial increase in the number of patients admitted to hospital for treatment has been reported since the guidance changed. 19 A review could identify new measures to reduce the incidence of therapeutic overdose and reduce the number of low risk patients being unnecessarily treated with a time consuming antidote that commonly produces adverse reactions and results in substantial hospital bed occupancy.…”

Section: Editorials How Many Tablets Do I Take?mentioning

confidence: 99%

Where are we now with paracetamol?

Dear

Antoine

Park

2015

BMJ

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“…At present, few data exist concerning the impact on rates of occurrence of liver injury or adverse acetylcysteine effects. Early reports from the UK indicate that, since September 2012, there have been increased numbers of patients receiving acetylcysteine, increased hospitalisation and a substantial financial burden (Thompson et al 2013; Bateman et al 2014a). …”

Section: Introductionmentioning

confidence: 99%

The 100 most influential publications in paracetamol poisoning treatment: a bibliometric analysis of human studies

et al. 2016

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BackgroundAnalysis of the most influential publications within paracetamol poisoning treatment can be helpful in recognizing main and novel treatment issues within the field of toxicology. The current study was performed to recognize and describe the most highly cited articles related to paracetamol poisoning treatment.MethodsThe 100 most highly cited articles in paracetamol poisoning treatment were identified from the Scopus database in November 2015. All eligible articles were read for basic information, including total number of citations, average citations per year, authors’ names, journal name, impact factors, document types and countries of authors of publications.ResultsThe median number of citations was 75 (interquartile range 56–137). These publications were published between 1974 and 2013. The average number of years since publication was 17.6 years, and 45 of the publications were from the 2000s. A significant, modest positive correlation was found between years since publication and the number of citations among the top 100 cited articles (r = 0.316; p = 0.001). A total of 55 journals published these 100 most cited articles. Nine documents were published in Clinical Toxicology, whereas eight documents were published in Annals of Emergency Medicine. Citations per year since publication for the top 100 most-cited articles ranged from 1.5 to 42.6 and had a mean of 8.5 citations per year and a median of 5.9 with an interquartile range of 3.75–10.35. In relation to the origin of the research publications, they were from 8 countries. The USA had the largest number of articles, 47, followed by the UK and Australia with 38 and nine articles respectively.ConclusionsThis study is the first bibliometric assessment of the top 100 cited articles in toxicology literature. Interest in paracetamol poisoning as a serious clinical problem continues to grow. Research published in high-impact journals and from high income countries is most likely to be cited in published paracetamol research.

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Impact of reducing the threshold for acetylcysteine treatment in acute paracetamol poisoning: The recent United Kingdom experience

Cited by 20 publications

References 9 publications

Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review

Current and future directions in the treatment and prevention of drug-induced liver injury: a systematic review

Where are we now with paracetamol?

The 100 most influential publications in paracetamol poisoning treatment: a bibliometric analysis of human studies

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