Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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Comparison of Silymarin, Penicillin, N-acetylcysteine in Patient with Amatoxin Poisoning: A Systematic Review

Amatoxin 중독 환자에서 Silymarin, Penicillin, N-acetylcysteine의 효과 비교: 체계적 고찰

  • Choi, Min Woo (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Ko, Dong Ryul (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Kong, Taeyoung (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Choa, Min Hong (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • You, Je Sung (Department of Emergency Medicine, Yonsei University College of Medicine) ;
  • Chung, Sung Phil (Department of Emergency Medicine, Yonsei University College of Medicine)
  • 최민우 (연세대학교 의과대학 응급의학교실) ;
  • 고동률 (연세대학교 의과대학 응급의학교실) ;
  • 공태영 (연세대학교 의과대학 응급의학교실) ;
  • 좌민홍 (연세대학교 의과대학 응급의학교실) ;
  • 유제성 (연세대학교 의과대학 응급의학교실) ;
  • 정성필 (연세대학교 의과대학 응급의학교실)
  • Received : 2018.05.06
  • Accepted : 2018.06.11
  • Published : 2018.06.30
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Abstract

Purpose: This study was conducted to evaluate the clinical efficacy of pharmacologic treatment of amatoxin poisoning patients. Methods: Literature was accessed through PubMed, EMBASE, Cochrane library, KoreaMed, KISS and KMBASE. Studies relevant to human use of pharmacologic therapy including silymarin, penicillin and N-acetylcysteine (NAC) for amanita poisoning were included. Case reports, letters, editorials and papers with insufficient information were excluded. Comparison of clinical outcomes (especially mortality and liver transplantation rate) in each study was analyzed. Results: The final analysis included 13 retrospective studies. None of these studies showed direct comparisons of individual agents. Among 12 studies comparing silymarin vs penicillin, eight showed clinical superiority of silymarin. Among eight studies comparing silymarin with NAC, six showed clinical superiority of silymarin. Among seven studies of NAC vs penicillin, five showed clinical superiority of NAC. Conclusion: This systematic review suggested that clinical superiority of various pharmacological agents used to treat amatoxin poisoning is debatable. Nevertheless, the available evidence suggests it is reasonable to consider combinations of multiple agents for patients with amanita poisoning. Further studies are required to establish a treatment regimen for amanita poisoning.

Keywords

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