[Chemical weapons: antidotes. View about the real means, perspectives].

Chemical methods remain a credible threat in 1999. The doctrine for their use not only includes the battlefield but also domestic terrorism as was disclosed during the Tokyo metro attempt in 1995. International Treaties have not yet proven their efficacy. The arsenal of chemical weapons has changed little since the second World War but is now dispersed into many high-risk zones throughout the world. There has also been little change in antidotes: therapeutic prevention with pyridostigmine against organo-phosphorus compounds, protective treatment for seizure-induced brain lesions using anticonvulsants in association with oxime for acetylcholinesterase reactivation, and atropine are combined in a three-compartment syringe. Preventive measures against vesicants and other suffocating or toxic intracellular substances (CN, AsH(3), fluorocarbons.) can only be achieved with protective skin covering or protective breathing devices. There is no specific treatment and we often have to use symptomatic medications. Future perspectives include: phosphotriesterases as organo-phosphorus scavengers, huperzine as pretreatment and gacyclidine (GCK 11) which would effectively complete emergency multiple drug therapy against nerve agents. A new two-compartment syringe is now prepared with atropine, avisafone and HI6 or pralidoxine. A gel made of cyclodextrines for external and eventually internal use is under study.