A study was performed to evaluate different recommendations about Amanita phalloides (APh) poisoning treatment. In a retrospective study mortality between 3 groups of patients, who underwent different therapeutic protocols in the last 30 years, was compared. In the first decade (1976-1985), patients were treated with high doses of crystalline penicillin and glucocorticoids. During the second decade (1986-1995), silibinin was added to the treatment protocol. In the last ten years (1996-2005), both penicillin and glucocorticoids were withdrawn from therapeutic guidelines; treatment relied on early silibinin and adequate symptomatic treatment. Concurrently we looked into possible prognostic value of prothrombin time and/or INR in predicting the severity and outcome of Aph poisoning. Patients were classified in 3 categories according to maximal values of prothrombin time (PT) and/or INR (>20%, 10-20%, <10% for PT and <4,4-5, >5 for INR). Diagnosis relied on mushroom identification the characteristic course of clinical symptoms and signs; in a few cases RIA for amanitine or Aph spore identification were also used.