Treatment of Amatoxin Poisoning: 20-Year Retrospective Analysis

Abstract

Benzylpenicillin (Penicillin G) alone and in association was the mostfrequently utilized chemotherapy but showed little efficacy. No benefit was found for the use of thioctic acid or steroids. Chi-square statistical comparison of survivors and dead vs. treated individuals supported silybin, administered either as mono-chemotherapy or in drug combination and N-acetylcysteine as mono-chemotherapy as the most effective therapeutic modes. Future clinical research should focus on confirming the efficacy of silybin, N-acetylcysteine, and detoxication procedures.

Alfa-Amanitin İle Oluşturulmuş Karaciğer Hasari Üzerine Enginar (Cynara scolymus) Sulu Yaprak Ekstresinin Etkileri

“…It was reported that silybin which was derived from Silybum marianum herb, and was water-soluble substance of silimarine derivative, decreased entrances of amatoxins into cells, so that they showed hepatoprotective effect [21] .…”

Mushroom poisoning in Hong Kong: a ten-year review

“…The remaining six cases were managed according to overseas experience in the treatment of amatoxin poisoning. [10][11][12] Treatment included intravenous silibinin, oral silymarin, intravenous Nacetylcysteine, oral multiple-dose activated charcoal, high-dose intravenous penicillin, and early charcoal haemoperfusion. Two local cases progressed to liver failure and required liver transplantation.…”

Mycetism: A Review of the Recent Literature

“…The antidotes benzylpenicillin, ceftazidime, Nacetyl-cysteine (NAC), rifamycin, and silibinin have been advocated by some [26,34,36,88,[110][111][112], and questioned by others [113,114]. Of these, silibinin and NAC show the most promise [32,34,111,115]. Magdalan [34] performed cell culture studies and found that hepatocytes poisoned with alpha-amanitin and simultaneously treated with NAC or silibinin showed less evidence of lipid peroxidation than poisoned hepatocytes simultaneously treated with benzylpenicillin or without an antidote treatment.…”

“…It is a scavenger of free radicals, has anti-inflammatory effects, stimulates protein synthesis, and inhibits amatoxin uptake by hepatocytes [26,34]. If silibinin is available, its administration seems reasonable [19,31,85,97,111,115,116]. Silibinin could potentially be obtained by contacting the researchers using this antidote through clinicaltrials.gov, using identifier NCT00915681.…”