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Effect of the UK's revised paracetamol poisoning management guidelines on admissions, adverse reactions and costs of treatment
Open accessAbstract
Aims: In S eptember 2012 the UK's Commission on Human Medicines (CHM) recommended changes in the management of paracetamol poisoning: use of a single ‘100 mg l−1’ nomogram treatment line, ceasing risk assessment, treating all staggered/uncertain ingestions and increasing the duration of the initial acetylcysteine (NAC) infusion from 15 to 60 min. We evaluated the effect of this on presentation, admission, treatment, adverse reactions and costs of paracetamol poisoning. Methods: Data were prospectively collected from adult patients presenting to three large UK hospitals from 3 S eptember 2011 to 3 S eptember 2013 (year before and after change). Infusion duration effect on vomiting and anaphylactoid reactions was examined in one centre. A cost analysis from an NHS perspective was performed for 90 000 patients/annum with paracetamol overdose. Results: There were increases in the numbers presenting to hospital (before 1703, after 1854; increase 8.9% [95% CI 1.9, 16.2], P = 0.011); admitted (1060/1703 [62.2%] vs. 1285/1854 [69.3%]; increase 7.1% [4.0, 10.2], P < 0.001) and proportion treated (626/1703 [36.8%] vs. 926/1854 [50.0%]; increase: 13.2% [95% CI 10.0, 16.4], P < 0.001). Increasing initial NAC infusion did not change the proportion of treated patients developing adverse reactions (15 min 87/323 [26.9%], 60 min 145/514 [28.2%]; increase: 1.3% [95% CI –4.9, 7.5], P = 0.682). Across the UK the estimated cost impact is £8.3 million (6.4 million–10.2 million) annually, with a cost‐per‐life saved of £17.4 million (13.4 million–21.5 million). Conclusions: The changes introduced by the CHM in S eptember 2012 have increased the numbers of patients admitted to hospital and treated with acetylcysteine without reducing adverse reactions. A safety and cost‐benefit review of the CHM guidance is warranted, including novel treatment protocols and biomarkers in the assessment of poisoning.
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The lower nomogram line has greatly increased the number of patients receiving acetylcysteine, increasing healthcare costs.
“The lower nomogram line has greatly increased the number of patients receiving acetylcysteine, increasing healthcare costs [77,79].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [77]
Patients with lower paracetamol levels have a greater rate of experiencing adverse effects when treated with NAC.
“Further, various studies have shown that patients with lower paracetamol levels have a greater rate of experiencing adverse effects when treated with NAC [77,80].”
From Paracetamol (acetaminophen) overdose and hepatotoxicity: mechanism, treatment, prevention measures, and estimates of burden of disease (2023) · cites this paper as [77]
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Self-citation
Metadata
- Authors
- Bateman, D. N., Carroll, R., Pettie, J., Yamamoto, T., Elamin, M. E. M. O., Peart, L., Dow, M., Coyle, J., Cranfield, K. R., Hook, C., Sandilands, E. A., Veiraiah, A., Webb, D., Gray, A., Dargan, P. I., Wood, D. M., Thomas, S. H. L., Dear, J. W., & Eddleston, M.
- Affiliations
- Edinburgh Royal Infirmary (GB)
- University of Bristol (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- King's College London (GB)
- Corresponding author
- Bateman, D. Nicholas
- ORCID
- Venue
- British Journal of Clinical Pharmacology
- Publisher
- Wiley
- Published
- 2014-08-21
- Volume
- 78
- Issue
- 3
- Pages
- 610-618
- ISSN
- 0306-5251 (ISSN-L)
- 1365-2125
- PMC
- PMC4243911
- OpenAlex
- W2119604663
- Cited by
- 131
- References
- 22
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 9 · 2023: 6 · 2022: 8 · 2021: 4 · 2020: 11 · 2019: 18 · 2018: 7 · 2017: 17 · 2016: 18 · 2015: 16 · 2014: 8
- FWCI
- 20.97
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Clinical Pharmacology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Explore Bristol Research (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc)
- Funders
- National Institute for Health and Care Research (DRF-2012-05-189)
- Scottish Funding Council
- Topics
- Health Sciences › Medicine › Emergency Medicine › Poisoning and overdose treatments
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- acetaminophen toxicity, acetaminophen overdose, N-acetylcysteine, treatment guidelines, hospitalization, adverse drug reactions, anaphylactoid reactions, treatment costs, cost per life saved, guideline implementation
- MeSH terms
- Acetaminophen, Acetylcysteine, Adolescent, Adult, Aged, Aged, 80 and over, Antidotes, Child, Child, Preschool, Female, United Kingdom, Hospitalization, Humans, Infant, Male, Middle Aged, Prospective Studies, Health Care Costs, Practice Guidelines as Topic, Risk Assessment, Young Adult
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