Organophosphorus (OP) poisoning is common in the farming community. We report our experience with the use of Pralidoxime (P2 AM) in the management of patients with OP poisoning in a prospective trial. Hundred and ten consecutive adult patients presenting to a large university affiliated teaching institution with a history of consumption of OP compounds and requiring intensive care were randomized using a block randomisation schedule to receive either placebo (normal saline infusion) over 3 days or P2 AM infusion (12 gm) over a 3 day period (treatment group). A higher mortality (p = 0.001) was observed in the treatment group even after controlling for other variables. Ventilatory requirements were also more in the treatment group (p = 0.004). The duration of ventilation was however similar in both groups. The incidence of intermediate syndrome (p = 0.001) and infections (p = 0.008) was significantly higher in the treatment group. High dose P2AM infusion has no role in the routine management of patients with OP poisoning.