Terrorist organophosphate (OP) poisoning: pharmaceutical organization for the preparation of an antidotal treatment

E. Jandot, E. Diouf, D. Salmon, V. Lebreton, C. Paillet, C. Pivot, F. Pirot Groupement Hospitalier Centre - Hôpital Edouard Herriot - Service Pharmacie
Unité Préparation et Contrôle du Médicament - Lyon, France

Introduction

OP are lethal products causing hypoxia. A rapid antidote administration is a priority. Atropine sulfate (AS), is available in injectable solution (1 mg – 1 ml) and in prefilled syringe (1 mg – 5 ml) like antidote for muscarinic syndrome. In case of poisoning, the quantity of AS required can be important (2 mg every 5 to 10 minutes). Thus, these dosage forms are inappropriate. We conducted an assessment of availability of glass vials and prefilled syringes of AS (5 mg/ml) prepared by preparation unit of hospital pharmacy department in emergency situation.

Material and methods

Injectable solution of AS (250 mg – 50 ml) were prepared in aseptic conditions, sterilized by autoclaving, and packed in glass vials. These vials were provided to intensive care units for continuous infusion of AS. The vials were divided in prefilled syringes (5 mg – 1 ml) in aseptic conditions and stored in hospital pharmacy department. An emergency kit was also prepared convenient for fast preparation of syringes. A syringe preparation test (n = 70, 4 persons) was achieved to test supplying time of antidote. Then, handling tests of syringes by staff wearing decontamination suits were performed.

Results and discussion

Timing to prepare and provide syringes was about 40 minutes. This period was assessed inappropriate in emergency situation. Risk analysis of prefilled syringes (AMDEC method) was low and moderate in early and emergency preparation respectively. Polycarbonate syringes handling test with butyl gloves showed adequate mechanical resistance and practical use.

Conclusion

Advance syringe preparation and organization for emergency preparation of prefilled syringe are necessary to provide antidotal treatment as quickly as possible.

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