A Meta-Analysis Of Oral Versus Intravenous N-Acetylcysteine Therapy For Paracetamol Poisoning
- Author:
Yong Loo Lin
- Publication Type:Journal Article
- Keywords:
Paracetamol Poisoning, N-Acetylcysteine, Oral Administration, Intravenous, Delayed Treatment
- From:ASEAN Journal of Psychiatry
2016;17(2):171-178
- CountryMalaysia
- Language:English
-
Abstract:
Paracetamol overdose is the most common cause of drug-related
poisoning and death worldwide. Although N-acetylcysteine is the widely accepted
antidote for paracetamol poisoning, much debate persist regarding the
appropriate route and duration of early N-acetylcysteine therapy. There is a
paucity of studies comparing the effectiveness of oral and intravenous (IV)
acetylcysteine for paracetamol poisoning. Methods: A literature search was
performed using the keywords [paracetamol OR acetaminophen] AND
[acetylcysteine OR n-acetylcysteine] on the PubMed and Ovid database. The
literature search was limited to human exposure studies published in English
between 1-Jan-1966 and 1-May-2015. The proportion of patients who developed
hepatotoxicity (defined as serum transaminase greater than 1000 IU/L) for each
route of administration was determined using multiple regression and the studies
were further stratified by early (less than 10 hours from ingestion) and late
treatment (longer than 10 hours from ingestion). Results: 3,981 full studies were
reviewed for data. Studies with fewer than 20 subjects were excluded. Metaanalysis
revealed that the overall proportion of patients who developed
hepatotoxicity was 12.3% (95% confidence interval [CI]: 9.6% to 17.2%). The
percentages were similar when studies were stratified by route of administration;
the proportion for IV treated patients was 12.6% (95% CI: 8.7% to 19.4%)
while the proportion for oral treated patients was 12.0% (95% CI: 8.2% to
18.8%). However, there was a marked difference in the percentage of patients
who developed hepatotoxicity with early as compared to late N-acetylcysteine
treatment. There was a statistically significant effect due to time (p < 0.001) but
no significant effect due to route of administration (p = 0.716). Conclusion:
Pooled analysis of studies did not find any significant difference in outcome
between oral and IV N-acetylcysteine therapy, but these findings require
confirmation by randomized controlled trials. However, overall hepatotoxicity
was significantly worse if treatment was delayed beyond 8 to 10 hours. ASEAN
Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.
- Full text:P020170619554519344333.pdf
