Mortality rate in amatoxin poisoning with different antidotal treatments

A retrospective study was undertaken to find out the influence of different so-called antidotal treatments for amanita poisoning. Two groups of patients with amatoxin intoxication were recruited. Firstly a mono-centre evaluation from our treatment centre (Munich) including 274 patients was done. Secondly 315 cases from a post-marketing surveillance by the Madaus firm in patients receiving silibinin in different hospitals and countries were studied. Antidotal treatment and mortality was looked at in both groups. Patients from the Munich subgroup: From 1957 till 1970 78 cases were treated with no antidote. From 1970-1980 43 patients were treated with penicillin only, from 1980-1993 108 cases were treated with silibinin plus penicillin. From 1997-2003 45 cases were treated with silibinin only. One patient from the silibinin plus penicillin group and 4 patients from the silibinin only group underwent liver transplantation (LTx). Patients from the Madaus subgroup: 204 patients were treated with silibinin + penicillin or/and cephalosporins. 111 cases were treated just with silibinin. Taking only the results from Munich into consideration, no improvement no matter what "antidotes" have been used could be found. The Madaus post-marketing surveillance study points to a 100% improvement if silibinin is used alone. Treatment with a combination of antidotes with silibinin has the same mortality rate as the Munich group. We suspect a reporting bias in the Madaus surveillance because no patient with LTx shows up there. Possibly these cases were not reported because no one felt responsible to report them after successful transplantation.