Inadequate stocking of antidotes in Taiwan: Is it a serious problem?

Objective: Insufficient hospital stock of a variety of poisoning antidotes is a worldwide problem. In an attempt to establish an antidote storage and distribution system for the response of the various poisoning accidents, we conducted a nationwide survey to characterize the current availability of selected antidotes and their anticipated need in Taiwan. Materials and Meth ods: A questionnaire was mailed to 834 hospitals to gather information on t he availability, anticipated need, and preferred purchase policy of 20 sele cted antidotes. A survey on the availability of cyanide antidote in 523 cya nide-handling facilities and their neighboring hospitals was also conducted . Results: Hospitals of different size and service levels had a statistical ly significant difference in response rates. Except for pyridoxine, the ava ilability and anticipated need for antidotes also varied significantly amon g different hospital groups. We found that physostigmine, cyanide antidote kit, BAL, EDTA, methylene blue, Vipera Russell formosensis antivenin, and b otulism antitoxin were not available in most (> 90%) hospitals. Interesting ly, these antidotes are also among the most needed antidotes. Most hospital s preferred a government-ordered purchase of antidotes. In the survey of cy anide-processing facilities, a response rate of 24.1% was obtained and only 9.3% of these 107 facilities that both replied to the questionnaire and co ntinued handling cyanide products had stocked cyanide antidote. It is notew orthy that cyanide antidote was also frequently lacking in the neighboring hospitals. Conclusions: The appropriate storage of antidotes in hospitals o r workplaces in rural areas is instrumental in the timely treatment of cert ain poisonings, while nationwide unavailability is the critical problem. Ra ising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions.