Antidote stocking in acute hospitals in the United Kingdom

To survey the availability of antidotes in acute hospitals in the United Kingdom following the publication of joint College of Emergency Medicine and National Poisons Information Service guidelines on antidote stocking in 2008. Methods: A questionnaire was sent to the Chief Pharmacist in 224 hospitals with emergency departments in the UK in July 2010 requesting information on the availability of 28 antidotes categorised in 3 groups: available immediately (category A), available within 1 hour (category B) and available supra-regionally (category C). Results: Completed questionnaires were received from 196 (87.5%) of the 224 hospitals by the survey completion date of 31st January 2011. In the category A list of antidotes, commonly used antidotes such as acetylcysteine, activated charcoal, naloxone, flumazenil were available for immediate use in more than 90% of hospitals surveyed but the availability of cyanide antidotes was much lower. Dicobalt edetate, currently recommended as the antidote of choice for severe confirmed cyanide poisoning, was available immediately in 144 (74%) and was not stocked in 29 (15%) hospitals. Hydroxocobalamin, sodium nitrite and sodium thiosulphate were available for immediate use in 21%, 57% and 66% of hospitals respectively. In the category B list, dantrolene, desferrioxamine and phytomenadione (vitamin K) were available for use within 1 hour in more than 90% of hospitals but there was poor availability of cyproheptadine (45%), viper venom antiserum (45%), pralidoxime (30%) and antidotes used for the treatment of toxic alcohol poisoning, with intravenous ethanol being available within 1 hour in 72%, oral ethanol in 28% and fomepizole in 18% of hospitals. Antidotes which are rarely used and recommended for supra-regional stocking were stocked in few hospitals, ranging from 4% for DMSA and DMPS, 20% for botulinum antitoxin and 25% for sodium calcium edetate. Conclusion: Commonly indicated antidotes are widely available but there is inconsistent stocking of less commonly used antidotes, for example those used to treat poisoning with organophosphorus insecticides, cyanide and toxic alcohols. This is of concern because these agents are frequently associated with severe morbidity and mortality and the timely use of an appropriate antidote may be life-saving in these situations.