PNS7 ROLE OF N-ACETYL CYSTEINE IN RODENTICIDE POISONING: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objectives: The role of N-Acetyl cysteine (NAC) in Rodenticide poisoning hasn’t been well established due to mixed results from various studies and lack of proper treatment guidelines. We aimed to evaluate the efficacy of NAC in the treatment of rodenticide poisoning. Methods: PubMed/MEDLINE, Scopus and the Cochrane Library were searched to identify the literature. Reference list of included studies and Clinicaltrials.gov were also searched for relevant studies. Only the Randomized controlled trials and observational studies assessing the efficacy of NAC in rodenticide poisoning published in English were included in our review. Cochrane Risk of Bias Assessment Tool and New Castle Ottawa scale was used for quality assessment. Two authors were independently involved in study selection, data extraction and quality assessment of the studies and disagreements were resolved by discussion or by consulting a third reviewer. Results: A total of 5 out of 2142 non-duplicate studies with 258 patients were considered for the analysis. Treatment with NAC was observed to have a better recovery rate (Odds Ratio [OR]: 2.32, 95% Confidence Interval [CI]: 1.32-4.09; 5 studies), lesser mortality (OR: 0.28, 95% CI: 0.15-0.53, 5 studies) and lesser intubation or ventilation rate (OR: 0.25, 95% CI: 0.11-0.60, 2 studies) when compared to the control group. However, there was no significant difference with respect to the hospitalization days (Mean Difference: 0.61, Standard deviation: -0.84 to 2.05, 3 studies). The quality of the included studies appeared to be moderate to high. Conclusions: Our findings indicate that NAC can be a promising agent in the management of rodenticide poisoning as it is showing a better survival and lower mortality rate when compared to the control group. Further high-quality studies are warranted. KEY WORDS: N-Acetyl Cysteine, Rodenticide, Efficacy, Recovery, Meta-analysis