Trends in antidote use in France from 2015 to 2021: a nationwide poison centers study

The French Poison Centers database is a tool of choice for the analysis of poisoning cases requiring the administration of an antidote although not all uses are systematically reported. This national retrospective study aims to report trends of use of antidotes in France over a 7-year period from 2015 to 2021. A total of 25,289 cases of poisoning required the administration of an antidote, among which 46.7% were moderate to severe. While 77.1% of poisonings progressed toward recovery, the observed mortality rate was 1.7%. The 3 most frequently used antidotes according to data from Poison Centers were N-acetylcysteine (n = 13,555 [53.6%]), flumazenil (n = 3102 [12.3%]) and naloxone (n = 1740 [6.9%]) reflecting the most common types of poisoning involving acetaminophen, benzodiazepines, and opioids. The observed use of methylthioninium chloride, hydroxocobalamin, cyanocobalamin and DOAC reversal agents increased, both in terms of absolute numbers and proportions, revealing new behaviors leading to poisoning, such as nitrous oxide consumption. Conversely, the observed use of ethanol-based therapy, L-carnitine, and dantrolene decreased over time, reflecting both current medical practices and shifts in guidelines. This study provides a novel insight into the typology (circumstances, severity, development) of poisonings requiring an antidote, as well as the description of the causative agents.