J Korean Soc Clin Toxicol.  2018 Jun;16(1):33-41. 10.22537/jksct.2018.16.1.33.

Comparison of Silymarin, Penicillin, N-acetylcysteine in Patient with Amatoxin Poisoning: A Systematic Review

• Choi MW
• Ko DR
• Kong T
• Choa MH
• You JS
• Chung SP

• KMID: 2436262
• DOI: http://doi.org/10.22537/jksct.2018.16.1.33

Abstract

PURPOSE
This study was conducted to evaluate the clinical efficacy of pharmacologic treatment of amatoxin poisoning patients.
METHODS
Literature was accessed through PubMed, EMBASE, Cochrane library, KoreaMed, KISS and KMBASE. Studies relevant to human use of pharmacologic therapy including silymarin, penicillin and N-acetylcysteine (NAC) for amanita poisoning were included. Case reports, letters, editorials and papers with insufficient information were excluded. Comparison of clinical outcomes (especially mortality and liver transplantation rate) in each study was analyzed.
RESULTS
The final analysis included 13 retrospective studies. None of these studies showed direct comparisons of individual agents. Among 12 studies comparing silymarin vs penicillin, eight showed clinical superiority of silymarin. Among eight studies comparing silymarin with NAC, six showed clinical superiority of silymarin. Among seven studies of NAC vs penicillin, five showed clinical superiority of NAC.
CONCLUSION
This systematic review suggested that clinical superiority of various pharmacological agents used to treat amatoxin poisoning is debatable. Nevertheless, the available evidence suggests it is reasonable to consider combinations of multiple agents for patients with amanita poisoning. Further studies are required to establish a treatment regimen for amanita poisoning.

Keyword

Amatoxin; Poisoning; Silymarin; Silibinin; Penicillin; Acetylcysteine

MeSH Terms

Acetylcysteine*
Amanita
Humans
Liver Transplantation
Mortality
Penicillins*
Poisoning*
Retrospective Studies
Silymarin*
Treatment Outcome
Acetylcysteine
Penicillins
Silymarin