Sixty years of oxime research are sixty years of hope and despair. Enthusiastic reports on oxime effectiveness are accompanied by denial of any benefit of oximes in OP poisoning. Despite the synthesis of several thousand oxime structures in the past decades only few, rather old oximes are in clinical use which indicates that either none of the novel structures has superior properties in comparison to the established oximes or that other factors, e.g. synthesis, stability or toxicity, prevented the transfer of experimental compounds into advanced development...
In the end, it is necessary to accept the limitations of oxime therapy. In dependence of the incorporated OP, its dose, the available oxime and the therapeutic regimen the therapeutic effectiveness of an oxime will be variable. Oximes may fail in case of high dose poisoning, delayed treatment and inadequate dosing and duration of oxime administration. Improvement of oxime effectiveness could be achieved by combination of oximes with a complimentary spectrum and prospectively by adjuncts like antinicotinics or (bio)scavengers.
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