Organophosphorus (OP) pesticides and nerve agents still pose a threat to the population. Treatment of OP poisoning is an ongoing challenge and burden for medical services. Standard drug treatment consists of atropine and an oxime as reactivator of OP-inhibited acetylcholinesterase and is virtually unchanged since more than six decades. Established oximes, i.e. 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. Moreover, the value of oximes in human OP pesticide poisoning is still disputed. 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. 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. 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. 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.

有机磷（OP）杀虫剂和神经毒剂仍然对人们构成威胁。有机磷中毒的治疗对医疗服务来说是一个持续的挑战和负担。标准药物治疗由阿托品和肟组成，作为 OP 抑制的乙酰胆碱酯酶的再激活剂，并且自六十多年来几乎没有变化。已确定的肟，即解磷定、比比肟、TMB-4、HI-6和MMB-4，在某些中毒中效果不足，并且常常仅覆盖有限范围的不同神经毒剂和杀虫剂。此外，肟在人类OP农药中毒中的价值仍存在争议。长期的研究工作导致了无数实验肟的制备，以及最近的非肟重激活剂，旨在取代或补充已建立和许可的肟。这种开发的进展缓慢，并且似乎没有一种新化合物适合转移到高级开发或临床使用中。这种情况需要对肟作为主要治疗方法的价值以及现有和新型激活剂的潜力和局限性进行批判性分析。需要解决直接鉴定优质再激活剂及其开发为许可药物的要求，以及临时解决方案的选择，作为在可预见的时间范围内改善OP中毒治疗的机会。