Medical treatment for botulism

Chalk C, Benstead TJ, Keezer M

Published Online:

March 16, 2011

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.

Abstract (click to read)

Background:

Botulism is an acute paralytic illness caused by a neurotoxin produced by Clostridium botulinum. Supportive care, including intensive care, is key but the role of other medical treatments is unclear.

Objectives:

To assess the effects of medical treatments on mortality, duration of hospitalization, mechanical ventilation, tube or parenteral feeding and risk of adverse events in botulism.

Search strategy:

We searched the Cochrane Neuromuscular Disease Group Specialized Register (10 January 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (10 January 2010 in The Cochrane Library, Issue 4 2010), MEDLINE (January 1966 to January 2011) and EMBASE (January 1980 to January 2011). We reviewed bibliographies, and contacted authors and experts.

Selection criteria:

We included randomized and quasi-randomized controlled trials examining the medical treatment of any of the four major types of botulism (infant intestinal botulism, food-borne botulism, wound botulism and adult intestinal toxemia). Medical treatments included equine serum trivalent botulism antitoxin, human-derived botulinum immune globulin, plasma exchange, 3,4-diaminopyridine and guanidine.

Data collection and analysis:

Two authors selected studies, assessed risk of bias and extracted data independently onto data extraction forms.

Our primary outcome was in-hospital death from any cause occurring within four weeks. Secondary outcomes were death occurring within 12 weeks, duration of hospitalization, mechanical ventilation, tube or parenteral feeding and risk of adverse events.

Main results:

A single randomized controlled trial met the inclusion criteria. This trial evaluated human-derived botulinum immune globulin for the treatment of infant botulism. This study included 59 treatment patients and 63 control patients. There were no deaths in either group making any treatment effect on mortality inestimable. There was a significant benefit in the treatment group on duration of hospitalization (mean difference (MD) 3.10 weeks, 95% confidence interval (CI) 1.68 to 4.52), mechanical ventilation (MD 2.60 weeks, 95% CI 1.14 to 4.06), and tube or parenteral feeding (MD 6.40 weeks, 95% CI 2.80 to 10.00) but not on risk of adverse events or complications (relative risk reduction 0.92, 95% CI 0.72 to 1.18; absolute risk reduction 0.06, 95% CI 0.22 to -0.11).

Authors' conclusions:

There is good evidence supporting the use of human-derived botulinum immune globulin in infant intestinal botulism. A single randomized controlled trial demonstrated significant decreases in the duration of hospitalization, mechanical ventilation and tube or parenteral feeding among treated patients. Our search did not reveal any evidence examining the use of other medical treatments including serum trivalent botulism antitoxin.

This record should be cited as:

Chalk C, Benstead TJ, Keezer M. Medical treatment for botulism. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD008123. DOI: 10.1002/14651858.CD008123.pub2

Assessed as up to date:

January 23, 2011

Health topics:

Child health > Infectious disease > Zoonotic & rare diseases

Child health > Neurology > Neuromuscular junction disorders

Infectious disease > Zoonotic & rare diseases > Botulism

Neurology > Neuromuscular junction disorders > Other

Cochrane Summaries

Independent high-quality evidence for health care decision making

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