N-Acetyl Cysteine in Rodenticide Poisoning: A Systematic Review and Meta-Analysis

Muhammed Rashid, Viji Pulikkel Chandran, Sreedharan Nair, Deepa Sudalai Muthu, Jemima Pappuraj, Krupa Ann Jacob, Balaji Sridhar, Karen Mark, Shabnam Hyder, Sohil Khan, Girish Thunga

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)


Background: Treatment with N-Acetyl Cysteine (NAC) in rodenticide poisoning has not been well established due to mixed study results and insufficient evidence. This review aimed to summarize the clinical benefits of NAC in the management of rodenticide poisoning. Methods: This review follows the PICOS framework and the PRISMA guidelines. Pub-Med/MEDLINE, Scopus, and the Cochrane library were searched to identify the published literature from inception to September 2020, and a reference search was performed for additional relevant stud-ies. The English language studies addressing the use of NAC in rodenticide poisoning were considered for the review. We considered all experimental and observational studies due to the insufficient num-ber of interventional studies. Results: Ten studies (two RCTs, four observational, and four descriptive) out of 2,178 studies with 492 participants were considered for the review. Only six studies (two RCTs, one prospective, and three retrospective studies) reported recovery and mortality. Pooled results of RCTs (n=2) showed a significant recovery rate (Odds Ratio [OR]: 3.97; 95% Confidence Interval [CI]:1.69-9.30), whereas summary estimates of prospective and retrospective studies recorded a non-significant effect. Meta-analysis of RCTs (OR: 0.25; 95% CI: 0.11-0.59; n=2) and retrospective studies (OR: 0.34; 95% CI: 0.15-0.78; n=3) showed a significant reduction in mortality, whereas pooled analysis of prospective studies recorded a non-significant effect. A significant reduction in intubation or ventilation (OR: 0.25; 95% CI: 0.11-0.60; 2 RCTs) and a non-significant (P=0.41) difference in duration of hospitaliza-tion was observed with NAC when compared to the non-NAC treated group. The quality of the in-cluded studies appeared to be moderate to high. Conclusion: Our findings indicate that NAC showed better survival and lower mortality rate when compared to non-NAC treated group; hence NAC can be considered for the management of rodenti-cide poisoning.

Original languageEnglish
Pages (from-to)192-204
Number of pages13
JournalCurrent Reviews in Clinical and Experimental Pharmacology
Issue number3
Publication statusPublished - 11-2022

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)
  • General Medicine


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