How is botulism treated?

Updated: Feb 15, 2019
  • Author: Kirk M Chan-Tack, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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On March 22, 2013, the FDA approved the first botulism antitoxin that can neutralize all 7 known botulinum nerve toxin serotypes. The heptavalent antitoxin is derived from horse plasma and is the only drug available for treating botulism in patients older than 1 year, including adults. It is also the only available drug for treating infant botulism that is not caused by nerve toxin type A or B. [8, 9, 10, 11]

Rigorous and supportive care is essential in patients with botulism.

Meticulous airway management is paramount, as respiratory failure is the most important threat to survival in patients with botulism.

Patients with symptoms of botulism or known exposure should be hospitalized and closely observed.

Spirometry, pulse oximetry, vital capacity, and arterial blood gases should be evaluated sequentially.

Respiratory failure can occur with unexpected rapidity.

Intubation and mechanical ventilation should be strongly considered when the vital capacity is less than 30% of predicted, especially when paralysis is progressing rapidly and hypoxemia with hypercarbia is present.

Many patients require intubation and ventilatory support for a few days to months.

Tracheostomy may prove necessary to manage secretions.

Patients with bowel sounds are administered cathartics and enemas to remove unabsorbed botulinum toxin from the intestine.

Magnesium salts, citrate, and sulfate should not be administered because magnesium can potentiate the toxin-induced neuromuscular blockade.

Stress ulcer prophylaxis is also a standard component of intensive care management.

If an ileus is present, nasogastric suction and intravenous hyperalimentation are very helpful supportive measures. If no ileus is present, tube feeding can be used for nutritional supplementation.

A Foley catheter is often used to treat bladder incontinence. This must be monitored conscientiously and changed regularly.

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