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Medical treatment for botulism

Chalk CH, Benstead TJ, Keezer M
Published Online: 
20 February 2014

Review question

We reviewed evidence on the effect of medical treatment on human botulism.

Background

Botulism is a serious illness that starts suddenly and causes paralysis (an inability to use muscles). A germ called Clostridium botulinum is the cause. If left untreated, a lot of people who have botulism die. There are four main types, adult and infant types where the intestine (gut) is infected; botulism from contaminated food; and wound botulism. We assessed the evidence on the effect of medical treatment on human botulism.

We searched for clinical trials of medicines for any of the four major types of botulism. We decided to assess the effects of treatment on the rate of deaths in hospital from any cause within four weeks. We were also interested in deaths within 12 weeks, length of hospital stay, the need for a ventilator to help with breathing (mechanical ventilation), feeding by tube, and harmful events.

Study characteristics

Once we had searched the medical literature and checked the results, we found only one randomized controlled trial (RCT), which was in infant botulism. The treatment was a single dose of a medicine made from human immune proteins (human-derived botulinum immune globulin or BIG). In the trial, 59 participants received BIG and 63 received an inactive treatment.

Key results and quality of the evidence

There were no deaths in either group in the trial. Infants treated with BIG were in hospital for three weeks less, on average, and spent a shorter time on a ventilator. The average length of tube feeding in the BIG group was over six weeks less than in the control group. The risk of harmful effects was no greater with BIG than with the inactive treatment. The evidence was of high quality overall (moderate for time spent on a ventilator).

The review shows that there is evidence for the use of BIG to treat infant botulism. On the other hand, there is no evidence for or against botulism antitoxin or other medical treatments.

The evidence was up to date to March 2013, when we updated the searches and found no new trials.

This record should be cited as: 
Chalk CH, Benstead TJ, Keezer M. Medical treatment for botulism. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD008123. DOI: 10.1002/14651858.CD008123.pub3
Assessed as up to date: 
30 March 2013