Botulism is an acute illness which causes paralysis. It is caused by the bacterium Clostridium botulinum. Untreated, the death rate is very high. The authors reviewed the results of all randomized trials that examined the medical treatment of any of the four major types of botulism (infant intestinal botulism and adult intestinal toxemia which are caused by the bacterium growing in the intestine, food-borne botulism caused by eating food contaminated by the bacterium and wound botulism where a wound is infected by the botulinum toxin). The review authors looked at in-hospital death from any cause occurring within four weeks as their primary outcome, while secondary outcomes were death occurring within 12 weeks, length of hospital stay, mechanical ventilation to help with breathing, or parenteral feeding (tube feeding) and risk of adverse events. After their search of the literature the authors included only one randomized controlled trial which evaluated human-derived botulinum immune globulin for the treatment of infant botulism. This trial included 59 treatment participants and 63 control participants. The control group received a control immune globulin which did not have an effect on botulinum toxin. There were no deaths in either group. Treated patients were likely to have an average length of three weeks less in hospital and duration of mechanical ventilation, while the average length of tube or parenteral feeding in the treatment group was decreased by over six weeks compared to the control group. There was no increase in the risk of adverse events among the treatment group. The authors conclude that there is good evidence for the use of human-derived botulinum immune globulin for the treatment of infant botulism. On the other hand, there is no evidence to support or refute the use of trivalent botulism antitoxin or other medical therapies in botulism.
Medical treatment for botulism
March 16, 2011