A Comparison of Three Guidelines on Recommendations of Antidote Storage in the Hospital

Introduction: Antidote stocking is a crucial part in the treatment of poisoned patients. There are multiple guidelines providing recommendations on the stocking of antidotes. This study aimed to compare the recommendations in three different guidelines. Methods: Three guidelines on antidote stocking were compared: the United States’ Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care, the United Kingdom’s Royal College of Emergency Medicine and National Poisons Information Service Guideline on Antidote Availability for Emergency Departments, and Australia’s Queensland Poisons Information Centre (QPIC) guideline. The comparison focused on recommendations for antidote availability and stocking quantities. Results: The US, UK, and Australian guidelines made recommendations for 45, 40, and 40 antidotes, respectively. Antivenom recommendations differed significantly among the guidelines. Only the US and UK guidelines further categorised antidotes based on urgency, providing recommendations on whether antidotes should be immediately available or within an hour. The Australian guideline only provided recommendations on whether to stock the antidote, without specifying urgency. The three guidelines concurred in their recommendations for 22 antidotes that should be stocked in hospitals. The US and UK guidelines provided recommendations on the quantities of each antidote to be stored for treating an adult during the first 24 hours. The UK guideline also indicated any special storage conditions. In contrast, the Australian guideline recommended varying quantities of antidotes to be stored according to the locality of health facilities, with tertiary facilities recommended to keep the largest quantities and rural facilities the least. Conclusion: The recommendations from various guidelines concurred on most antidotes to be kept. Anti-venom recommendations differed, likely due to geographical variations. Storage quantity recommendations were based on amounts for initial treatment up to 24 hours or practical considerations such as locality.