Treating organophosphates poisoning: management challenges and potential solutions

Abstract

Organophosphorus agents (OP) are widely used as pesticides due to their cost effectiveness, yet they present a significant public health risk owing to their high toxicity, especially in cases of occupational exposure in agriculture, during suicide attempts using pesticides, and as nerve agents in warfare. Their vigorous permeability through inhalation, ingestion, and dermal exposure results in a high number of reported OP poisoning cases and alarming mortality rates. Initial first-aid management involves decontamination, ventilation, and hemodialysis. Additionally, current treatment guidelines recommend prompt administration of atropine as a first-line antidote, oximes as a follow-up, benzodiazepines for seizure control, and pyridostigmine for prophylaxis. Nevertheless, current treatment options are associated with several challenges. Thus, recent research has focused on investigating novel approaches for their potential in improving current management strategies. This article intends to review recent advances in OP poisoning treatment, including agents investigated for their use as an alternative or adjunctive therapy, novel formulations such as nasal drops or sublingual tablets for emergency administration of atropine, as well as innovative strategies for enhanced oximes delivery and overall efficacy. However, two major barriers may limit these innovations, ethical issues associated with their clinical assessment in emergencies, and limited profitability in countries where most cases occur.

Keywords:

• Atropine sulfate
• nerve agent
• organophosphates
• pesticides
• poisoning
• sarin
• soman
• tabun

Acknowledgements

The authors thank the anonymous peer reviewers for their constructive criticism and suggested additions. Their comments and suggestions were helpful to improve and clarify this publication.

Declaration of interest

The authors report no conflict of interest. The author’s affiliations are as shown on the cover page. The institutions with which the authors are affiliated are academic institutions, and the authors take sole responsibility for the writing and content of the manuscript. None of the authors have been involved in legal or regulatory matters related to the contents of the paper.

M. Rawas-Qalaji was the first inventor for multiple related patent applications and one granted European patent. These patent applications were for the development of atropine sublingual fast-disintegrating tablets for the emergency treatment of organophosphates toxicities.