Availability of Antidotes and Sufficiency of their Deposits in Greek Hospitals

Background: The particular geographical disposition of Greece - number of isolated communities and occasionally inaccessible islands - sets the necessity for a promptly available stock of antidotes for use by the local health care units. Objective: To define the sufficient amount of antidotes to fulfil the local necessities, establish a feedback system of exchanging information and improve the existing system. Method: Of 125 local health-care units, 92 had records of availability of 21 antidotes which have been categorized in three groups based on their emergency use: 1st group: prompt (atropine, flumazenil, naloxone, sodium nitrite, sodium thiosulphate, methylene blue, protamine sulphate); 2nd: in the first 12 hours (biperiden, Viper Venom Antiserum, dimercaprol, bentonite, calcium edetate, pralidoxime, desferioxamine, Digoxin Immune Fab, dicobalt edetate, silibinin, N-acetylcysteine, physos-tigmine; and 3rd: in the first 24 hours (vitamin K1, protamine sulphate). The hospitals have also been divided into three groups according to their geographical location: A) urban areas, B) difficult access areas, and C) remaining areas. Results: The average sufficiency of antidotes of the 1st group was found to be 48.87% in A, 45.71% in B and 45.18% in C areas; of the 2nd group 32.45% in A, 27.5% in B and 29.25% in C; whereas of the 3rd group it was 50% in A, 55% in B and 50% in C areas respectively. It is interesting to underline the difference in sufficiency of sodium nitrite (55.7%) in contrast with sodium thiosulphate (18.6%) despite the fact that they are administered together. Furthermore, the low percentage of adequacy of antidotes such as Digoxin Immune Fab (2.1%), Viper Venom Antiserum (14.4%) and pralidoximc (5.2%), which are crucial for the treatment of the respective poisonings, has to be emphasized. Conclusions: Taking into account that many areas are not easily accessible either because of their geographical position or due to difficult weather conditions, the deficiency of antidotes may prove fatal. The data collected indicate that the supplying of antidotes is not based on their necessity for therapies, but mainly on the frequency of incidents. This is why the operation of a Poison Information Centre, as well as its main function, is also important for the surveillance and the satisfactory availability of antidotes for the local health services.