Pralidoxime safety and toxicity in children

Currently, the safety of pralidoxime administration via adult autoinjectors for pediatric patients has not been established. Up until 2000, the published literature did not recommend its usage for children less than 12 kg or under the age of 10 years old. Since 2000, limited published articles have emerged validating adult autoinjector usage for the pediatric victim, in extreme circumstances.

We sought to determine whether adverse drug reactions (ADR) from pralidoxime administration to children occur.

Recurrent PubMed Medline literature search of all years were performed from 2001 to 2004 inclusive. The main search criteria were articles pertaining to U.S. children 16 years or younger who received pralidoxime. In addition, a review of 3 years (1999-2001) of detailed retrospective TESS exposure annual poison center data was obtained from the AAPCC.

Eighty-one children met inclusion criteria and received pralidoxime for suspected organophosphate poisoning. Two children (2.5%) expired. Three children (3.7%) were identified as having a potential adverse drug reaction; all were mild.

The author's recognize this study possesses limitations that require its findings be interpreted with caution. Our data suggest that adverse drug reactions to pralidoxime treatment in children are rare. However, further investigation is needed to more firmly establish the safety of this antidote in children and for its use in the prehospital environment.