INCORRECT OVERDOSE MANAGEMENT ADVICE IN THE PHYSICIANS DESK REFERENCE

Study hypothesis: Physicians may consult references such as Physicians ' Desk Reference (PDR) for overdose management advice. Although PDR re commendations are approved by the US Food and Drug Administration (FDA ), we hypothesized that they are often outdated and potentially hazard ous. Methods: We surveyed physicians who consulted our poison center d uring a 1-month period with regard to their use of the PDR for overdos e information and also compared PDR overdose treatment recommendations with those of five current major toxicology references. For the PDR o verdose information review, we examined data from the American Associa tion of Poison Control Centers to identify pharmaceutical categories w ith the largest number of deaths. We reviewed the four leading drugs w ith at least 1,000 reported exposures in each category and identified 20 PDR-listed brand-name products for analysis. We obtained the consen sus from five current toxicology references on contraindicated treatme nts, ineffective treatments, and specific recommended treatments or an tidotes. Finally, we compared the overdose management advice provided in the 1994 PDR with the toxicology reference consensus. Results: Fort y of 80 of physicians surveyed (50%) reported use of the PDR for overd ose information in the preceding 12 months. Of the 20 PDR entries, 16 (80%) had at least one deficiency, and 5 (25%) had two or more deficie ncies. Thirteen (65%) omitted an indicated specific treatment, three ( 15%) recommended contraindicated treatments, and four (20%) advised in effective treatments with potential for harm. Only four entries (20%) had no deficiencies by our survey criteria. Conclusion: We found serio us discrepancies in overdose treatment advice in the PDR compared with a consensus of current toxicology references. Altogether, four of fiv e PDR entries were deficient, and almost half advised ineffective or f rankly contraindicated therapies. Despite FDA approval, the use of PDR overdose advice in a serious poisoning case could result in unnecessa ry morbidity or mortality.