Botulism medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Michael Maddaleni, B.S., Tarek Nafee, M.D. [2]
Overview
The mainstay of therapy for botulism is antitoxin therapy. Antimicrobial therapy is recommended for wound botulism after antitoxin has been administered.
Medical Therapy
Clostridium botulinum is a toxin that paralyzes the muscles. Breathing requires the use of many muscles, including the diaphragm. Therefore, botulism will make breathing very difficult, so many people with botulism will need to be on a mechanical ventilator for a significant period of time, and Botulinum antitoxin should be administered as soon as possible. Antitoxin does not reverse paralysis but arrests progression.
Antimicrobial regimen
- 1.Foodborne botulism[1]
- 1.1 Adult
- Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min
- 1.2 Children
- 1.2.1 Children < 1 year
- Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (10% of adult dose regardless of body weight)
- 1.2.1 Children 1-17 years
- Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (20 – 100% of adult dose)
- Note:Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. A patient with severe botulism may require a ventilator as well as intensive medical and nursing care for several months.
- 2. Infant botulism[2]
- Preferred regimen: BabyBIG, Botulism Immune Globulin Intravenous (Human) (BIG-IV) is for the treatment of patients below one year of age.The recommended total dosage is 1mL/kg (50mg/kg), given as a single IV infusion as soon as the clinical diagnosis of infant botulism is made
- Note: infant with botulism must receive supportive care during their recovery. This includes ensuring proper nutrition,keeping the airway clear,watching for respiratory failure and if it develops,ventilator may be needed.
- 3. Wound botulism
- 3.1 Adult
- Preferred regimen (adult): Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min
- 3.2 Children
- 3.2.1 Children < 1 year
- Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (10% of adult dose regardless of body weight)
- 3.2.2 Children 1-17 years
- Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (20 – 100% of adult dose)
- Note (1): Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. A patient with severe botulism may require a ventilator as well as intensive medical and nursing care for several months.
- Note (2): For wound botulism, antibiotics are used in addition to appropriate debridement.
- Note (3): Antibiotic therapy is recommended for wound botulism after antitoxin has been administered. Penicillin G 3 MU IV q4h in adults is frequently used. Metronidazole 500 mg IV q8h may be used as an alternative for penicillin-allergic patients.
References