From the Guidelines
Amoxicillin is not recommended for treating mushroom poisoning. The standard treatments for mushroom poisoning depend on the type of toxin involved and typically include activated charcoal to prevent absorption, supportive care to manage symptoms, and specific antidotes like intravenous silibinin for amatoxin poisoning or atropine for muscarinic symptoms. According to the American Association for the Study of Liver Diseases (AASLD) position paper 1, penicillin G and silymarin are considered for administration in patients with known or suspected mushroom poisoning, but there is no mention of amoxicillin as a recommended treatment.
Antibiotics like amoxicillin have no role in treating mushroom toxicity because the illness is caused by toxins, not bacterial infection. In cases of suspected mushroom poisoning, immediate medical attention is essential, and treatment should focus on identifying the mushroom type if possible, decontamination, supportive measures, and specific antidotes when available. The timing of treatment is critical, especially with deadly mushrooms like Amanita species, where early intervention significantly improves outcomes. Penicillin G has been used in doses of 300,000 to 1 million units/kg/day, and silibinin has been given in average doses of 30-40 mg/kg/day for an average duration of 3 to 4 days 1.
Key considerations in the management of mushroom poisoning include:
- Identifying the type of mushroom involved, if possible
- Administering activated charcoal to prevent toxin absorption
- Providing supportive care to manage symptoms
- Using specific antidotes like intravenous silibinin for amatoxin poisoning or atropine for muscarinic symptoms
- Considering penicillin G and silymarin for patients with known or suspected mushroom poisoning, as recommended by AASLD 1.
From the Research
Amoxicillin in Mushroom Poisoning
- There is no direct evidence to suggest that amoxicillin (amoxcilline) is used in the treatment of mushroom poisoning 2, 3, 4, 5, 6.
- The treatment of mushroom poisoning primarily involves supportive care, gastrointestinal digestive decontamination, elimination enhancement, amatoxin uptake inhibitors, and antioxidant therapy 2.
- Combined therapy associating silibinin and N-acetylcysteine is recommended for amatoxin-containing mushroom poisoning 2.
- Penicillin G and silymarin may be useful in the treatment of mushroom poisoning, but there is no specific mention of amoxicillin 3, 4.
- The prognosis of mushroom poisoning has greatly benefited from improved resuscitation techniques, and mortality is currently less than 10% 2.
Treatment of Mushroom Poisoning
- Diagnosis of mushroom poisoning is based primarily on clinical data and can be biologically confirmed using detection of amatoxins, especially from urine samples 2.
- Therapeutic strategies include primary detoxification by induced emesis, gastric lavage, and activated charcoal, secondary detoxification, symptomatic treatment, and rarely specific antidotes 3.
- Orthotopic liver transplantation may be considered in severe cases of phalloides syndrome 3, 4.
- New techniques of extracorporeal detoxification, such as molecular absorbent recycling system (MARS), may represent an important support system in the treatment of mushroom poisoning 4.