Glucocorticoid with cyclophosphamide for paraquat-induced lung fibrosis

Department of Neurosurgery,West China Hospital, Sichuan University, Chengdu, China. .
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 07/2012; 7(7):CD008084. DOI: 10.1002/14651858.CD008084.pub3
Source: PubMed


Paraquat is an effective and widely used herbicide but is also a lethal poison. In many developing countries paraquat is widely available and inexpensive, making poisoning prevention difficult. However most of the people who become poisoned from paraquat have taken it as a means of suicide. Standard care for removing paraquat from the body involves vomiting, consuming activated charcoal or Fuller's Earth (which absorbs paraquat), and blood filtering. This review aims to assess the effects of giving patients steroids and cyclophosphamide in addition to standard care to prevent death after paraquat poisoning. We found three small randomised controlled trials in which patients with moderate or severe poisoning were given either standard care only or standard care and steroids and cyclophosphamide. When the results of the three studies were combined, we found that patients who were given standard care and steroids and cyclophosphamide had a reduced risk of death of about 28% (statistically estimated likely range of reduced deaths from 41% to 11%) compared with patients given standard care alone. However, the studies were small and one was of low methodological quality so the benefit of this treatment should be interpreted with caution. To understand the effects of this treatment for poisoned patients better, we recommend it be given in the context of a randomised controlled trial so that future results can be analysed with similar studies.

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