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Taking stock: UK national antidote availability increasing, but further improvements are required
  1. GP Bailey1,2,
  2. B Rehman3,
  3. K Wind4,
  4. DM Wood1,5,
  5. R Thanacoody6,7,
  6. S Nash8,
  7. JRH Archer1,
  8. M Eddleston9,
  9. JP Thompson10,
  10. JA Vale11,
  11. SHL Thomas6,7,
  12. PI Dargan1,5
  1. 1Department of Clinical Toxicology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Department of Emergency Medicine, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  3. 3London Medicines Information Service, London Northwest Healthcare NHS Trust, London, UK
  4. 4Pharmacy Department, Southend Hospital NHS Trust, Southend, UK
  5. 5Faculty of Life Sciences and Medicine, King's College London, London, UK
  6. 6National Poisons Information Service (Newcastle Unit), Newcastle Hospitals NHS Trust, Newcastle, UK
  7. 7Institute of Cellular Medicine, Newcastle University, Newcastle, UK
  8. 8Department of Emergency Medicine, Princess Royal University Hospital, London, UK
  9. 9National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh, UK
  10. 10National Poisons Information Service (Cardiff Unit), University Hospital Llandough, Cardiff, UK
  11. 11National Poisons Information Service (Birmingham Unit), City Hospital, Birmingham, UK
  1. Correspondence to Professor Paul I Dargan, Department of Clinical Toxicology, Guy's and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; paul.dargan{at}


Background A 2010/2011 audit of the Royal College of Emergency Medicine (RCEM) National Poisons Information Service (NPIS) UK guidelines on antidote availability demonstrated variable stocking of antidotes for the management of poisoned patients; the guidelines were updated and republished in 2013.

Aim To assess if antidote stocking has improved since the 2010/2011 audit and introduction of the 2013 guidelines.

Methods Questionnaires were sent to Chief Pharmacists at all 215 acute hospitals in England, Wales and Northern Ireland in October 2014. Data were collected on the timing of availability (category A antidotes should be available immediately, category B within 1 h and category C can be held supraregionally) and stock levels.

Results 169 (78.6%) responses were received. Atropine, calcium gluconate and flumazenil (category A) were the only antidotes available in all hospitals within the recommended time and stock levels. Forty-one (24.3%) hospitals held every category A antidote; this increased to 81 (47.9%) for those holding at least one cyanide antidote and all other category A antidotes. The proportion of hospitals stocking category A/B antidotes within the recommended time increased for 20 (90.9%) category A/B antidotes. Fomepizole (category B) availability increased to 62.1% of hospitals from 11.4% in 2010/2011. Other than penicillamine (63.3% hospitals), there was poor availability (2.4%–36.1%) of category C antidotes.

Conclusions Availability of category A and B antidotes has improved since the 2010/2011 audit and 2013 guidelines. However, there remains significant variability particularly for category C antidotes. More work is required to ensure that those treating poisoned patients have timely access to antidotes focusing particularly on category C antidotes.


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