Mannitol: the treatment of choice in the acute phase of ciguatera

Until the introduction of intravenous mannitol therapy, treatment for ciguatera was only symptomatic and supportive. Mannitol was first used in the Marshall Islands (Palafox et al., 1988) and soon after in Australia (Pearn et al., 1989). These studies both reported dramatic and sustained improvement in many of the victims of ciguatera. Specifically mannitol appeared to reduce the duration and severity of ciguatera. Several recent experiences with mannitol and ciguatera lend further support to these earlier studies. Mannitol is now the treatment of choice in the acute phase of ciguatera in Australia (Figure 1). Mannitol is most effective at reversing the neurological disturbances, particularly in the more severe cases of ciguatera.