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Chin Med J (Taipei) 1998;61:S7.
Swedish Poisons Information Centre, Stockholm, Sweden
The selection of antidotes is based on certain criteria, that are continuously considered (1) the particular toxic risks in the society as observed by the poisons centre through careful toxicovigilance and (2) evaluation of efficacy and usefulness of available antidotes through the study of literature, clinical reports etc. This means that the selection of antidotes is a dynamic process, introducing new agents and excluding others in accordance with real needs and scientific evidence.
Antidotes may be classified in many different ways. In this context - when compiling recommendations for antidote stocks - one practical way of classification is the urgency. Some antidotes must be given immediately, for others a time lapse is acceptable. Therefore we classified them in three categories: (A) immediate availability, (B) availability within 2 hours and (C) availability within 4-6 hours. This system will facilitate a regional and even nation-wide planning of the antidote supplies, and this will in its turn save money and efforts.
The antidote programme in Sweden is a joint activity where the poisons centre has the key role. The other partners are the National Corporation of Swedish Pharmacies and, of course, all hospitals in the country where poisoned patients are admitted. The principles for the antidote strategy are the following:
i. The poisons centre is every two years issuing a publication with an updated list of antidotes recommended for storage in the country. The list consists of true antidotes but also some other pharmaceuticals that through their importance in the treatment of poisoning touch on the concept of antidotes. For each antidote the indication(s) are giver and also the category in terms of urgency (A, B, C). To the list is also attached a chapter where detailed treatment guidelines are given for all poisonings where antidotes may be indicated. This publication is distributed, free of charge, to all pharmacies and doctors in the country.
ii. On the basis of this list the hospitals are setting up their antidote stores, and ideally attention should be paid to particular risks in their region and to possibilities of collaborating with other hospitals to reduce costs.
iii. The hospital pharmacies report continuously to the poisons centre about the contents of their antidote supplies. This is a great advantage as the centre thereby has an overview of the total situation in the country and immediately can inform any inquirer where a particular antidote is kept in stock.
This system has now been running since more than 20 years. It is smooth and functional, and nowadays it rarely happens - if ever - that a poisoned patient cannot get the appropriate antidote in time. Finally, the introduction of antidotes, where the documentation is acceptable has been quite non-bureaucratic and uncomplicated. The only problem in recent years has, in fact, been the very high price for certain new antidotes.
[Chin Med J (Taipei) 1998;61:S7.]
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Copyright: 1998, Chinese Medical Association (Taipei)