![]() Two contradictory statements “Hitherto, alkylphosphate poisoning has been treated mainly by atropine, but now atropine is replaced by PAM ” (Namba and Hiraki 1958) and “Based on the current available data on human organophosphate poisoning, oxime was associated with either a null effect or possible harm” (Peter et al. Requirements for a straightforward identification of superior reactivators and their development to licensed drugs need to be addressed as well as options for interim solutions as a chance to improve the therapy of OP poisoning in a foreseeable time frame. This situation calls for a critical analysis of the value of oximes as mainstay of treatment as well as the potential and limitations of established and novel reactivators. The progress of this development is slow and none of the novel compounds appears to be suitable for transfer into advanced development or into clinical use. Long-lasting research efforts resulted in the preparation of countless experimental oximes, and more recently non-oxime reactivators, intended to replace or supplement the established and licensed oximes. Moreover, the value of oximes in human OP pesticide poisoning is still disputed. ![]() pralidoxime, obidoxime, TMB-4, HI-6 and MMB-4, are of insufficient effectiveness in some poisonings and often cover only a limited spectrum of the different nerve agents and pesticides. Standard drug treatment consists of atropine and an oxime as reactivator of OP-inhibited acetylcholinesterase and is virtually unchanged since more than six decades. ![]() Treatment of OP poisoning is an ongoing challenge and burden for medical services. Organophosphorus (OP) pesticides and nerve agents still pose a threat to the population. ![]()
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