Botulism - Treatment

What kinds of medical treatment did you or someone you know receive for botulism?

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What is the treatment for botulism?

If diagnosed early, food-borne and wound botulism can be treated with an antitoxin that blocks the action of neurotoxin circulating in the blood. The trivalent antitoxin (effective against three neurotoxins: A, B, and E) is dispensed from quarantine stations by the U.S. government's Centers for Disease Control and Prevention (CDC). The antitoxin can prevent the disorder from worsening, but recovery still takes many weeks. Another heptavalent antitoxin (effective against seven neurotoxins: A, B, C, D, E, F, and G) may be available from the U.S. Army or FEMA. However, HBAT (botulinum antitoxin, heptavalent) is replacing other antitoxins and is available from the CDC Emergency Operations Center; call 770-488-7100 for information and supplies.

Physicians may remove whatever contaminated food is still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care (IV fluids, breathing support, for example) in a hospital is the mainstay of therapy for all botulism types.

Enemas may be used to remove unabsorbed toxin; however, magnesium salts, citrate, and sulfate are not used as they may add to the toxin's strength. Antibiotics (high-dose IV penicillins or other antibiotics) are not used in food-borne botulism but are used in wound botulism; surgical debridement may also be needed. Consultation with an infectious-disease specialist is recommended to help manage treatment protocols.

Antitoxin was not routinely given for the treatment of infant botulism. However, now recommended is the use of BabyBIG (human immune globulin given IV) that is considered safe and effective. Unfortunately, it can only be obtained from the California Department of Public Health (call 510-231-7600), and it reportedly costs $45,300. The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (mechanical ventilator) for weeks and may require intensive medical and nursing care (nasogastric suction, IV augmented nutrition, and Foley catheter, for example). After several weeks, the paralysis slowly improves as axons in the nerves are regenerated.

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