Title:N-Acetyl Cysteine in Rodenticide Poisoning: A Systematic Review and
Meta-Analysis
Volume: 17
Issue: 3
Author(s): Muhammed Rashid, Viji Pulikkel Chandran, Sreedharan Nair, Deepa Sudalai Muthu, Jemima Pappuraj, Krupa Ann Jacob, Balaji Sridhar, Karen Mark , Shabnam Hyder, Sohil Khan and Girish Thunga*
Affiliation:
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education,
Manipal, Karnataka- 576104, India
- Centre for Toxicovigilance and Drug Safety, Manipal
College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka- 576104, India
Keywords:
Efficacy, poison, rat poison, safety, yellow phosphorous, zinc phosphide.
Abstract:
Background: Treatment with N-Acetyl Cysteine (NAC) in rodenticide poisoning has not
been well established due to mixed study results and insufficient evidence. This review aimed to
summarize the clinical benefits of NAC in the management of rodenticide poisoning.
Methods: This review follows the PICOS framework and the PRISMA guidelines. Pub-
Med/MEDLINE, Scopus, and the Cochrane library were searched to identify the published literature
from inception to September 2020, and a reference search was performed for additional relevant studies.
The English language studies addressing the use of NAC in rodenticide poisoning were considered
for the review. We considered all experimental and observational studies due to the insufficient number
of interventional studies.
Results: Ten studies (two RCTs, four observational, and four descriptive) out of 2,178 studies with
492 participants were considered for the review. Only six studies (two RCTs, one prospective, and
three retrospective studies) reported recovery and mortality. Pooled results of RCTs (n=2) showed a
significant recovery rate (Odds Ratio [OR]: 3.97; 95% Confidence Interval [CI]:1.69-9.30), whereas
summary estimates of prospective and retrospective studies recorded a non-significant effect. Metaanalysis
of RCTs (OR: 0.25; 95% CI: 0.11-0.59; n=2) and retrospective studies (OR: 0.34; 95% CI:
0.15-0.78; n=3) showed a significant reduction in mortality, whereas pooled analysis of prospective
studies recorded a non-significant effect. A significant reduction in intubation or ventilation (OR:
0.25; 95% CI: 0.11-0.60; 2 RCTs) and a non-significant (P=0.41) difference in duration of hospitalization
was observed with NAC when compared to the non-NAC treated group. The quality of the included
studies appeared to be moderate to high.
Conclusion: Our findings indicate that NAC showed better survival and lower mortality rate when
compared to non-NAC treated group; hence NAC can be considered for the management of rodenticide
poisoning.
