Antidote Stocking at Hospitals in North Palestine

to the WHO guidelines for poisoning
control about antidotes and their avail-
ability.[17]

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There has been no study addressing
antidote stocking in Palestinian hospi-
tals. Therefore, the purpose of this
study was to determine the availability
and adequacy of antidote stocking at
hospitals in north Palestine based on
the published guidelines for antidotes
stocking. This will help the Poison Con-
trol and Drug Information Center
(PCDIC) in poison management.

Materials and Methods:
This is a cross sectional survey study
using a questionnaire. The study
included all hospitals (n=11) in north
Palestine that provide emergency
department and more than 20 acute
care beds. The hospitals names and
addresses were obtained from the
Palestinian ministry of health. A
questionnaire was designed by the
PCDIC at An-Najah National University
in Nablus and sent directly to the
director of each hospital on February
15, 2006, accompanied by an official
document explaining the purpose and
importance of the survey. The director
of the hospital was asked to assign a
pharmacist to complete the
questionnaire.

The questionnaire has two lists of
antidotes and the director of the
Pharmacy at each hospital was asked
to report the amount of each antidote
currently in stock anywhere in the
hospital (Table 1,2). The two lists
contained the various antidotes and
the adjunctive agents used for the
treatment of poisoning. The first list
contained 25 antidotes, those that
should be available in the hospital for
use within the first four hours of
poisoning; the second list contained 12
antidotes, those that should be
available in the hospital for use within
the first hour of poisoning. The two
lists were classified as such according
to the guidelines on the antidote
availability for accident and
emergency departments as published
by the BAEM and Guys & St Thomas’
poison units.[16]

For each hospital, antidote stocks were
categorized as either adequate or in-
adequate based on the published rec-
ommendations.[15,18,19] The recom-
mended amounts constitute the ap-
proximate quantities of antidotes
needed to initiate treatment for 1 case
of severe poisoning in an adult. The
availability of antidotes in each hospi-
tal were compared to the 16 antidotes
considered essential in Dart et al
guidelines for stocking antidotes.[15]
The 16 antidote and their clinical use
with the recommended dose to treat
one patient for the first 4 hours are
given in Table 3.

All data were entered and analyzed us-
ing Statistical Software for Social Sci-
ences program version 10.0 (SPSS Inc.,
Chicago, IL). Data are presented as
mean ± SD.

Results

All hospitals (n=11) responded to the
sent questionnaire. The overall
availability of each antidote in the first
list varied widely, it ranged from zero
(for glucagon and fomepizole) to
100% (for atropine and Naloxone)
(table 1). The number of antidotes
stocked in all hospitals ranged from 5
to 12 antidotes but no hospital stocked
all the 25 antidotes (mean 8.2 ±
2.36). The mean number of antidotes
stocked was. All hospitals stocked an
adequate supply of atropine, naloxone,
neostigmine, protamine sulphate and
phytonadione (Vit. K1). In contrast,
digoxin-specific fab antibodies, folic
acid injection, ethanol, fomepizole,
glucagon,                penicillamine,

physostigmine, succimer, and thiamine
were not available at any of the
surveyed hospital (Table 1).

Availability of antidote in the second
list varied widely from zero (for
polyethylene glycol) to 100% (for
dobutamine). The number of antidotes

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