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DRUG INFORMATION ROUNDS

Management of Botulism

Fellow, Pediatric Pharmacotherapy, College of Pharmacy, Ohio State University, Columbus, OH

Milap C Nahata, PharmD

Professor of Pharmacy and Division Chair, College of Pharmacy; Professor of Pediatrics and Internal Medicine, College of Medicine and Public Health, Ohio State University and Children's Hospital, Columbus, OH

Reprints: Milap C Nahata PharmD, College of Pharmacy, Ohio State University, 500 W. 12th Ave., Columbus, OH 43210-1291, FAX 614/292-1335

OBJECTIVE: To provide a concise review of the presentation and treatment of botulism.

DATA SOURCES: Searches of MEDLINE (1966–November 2001), tertiary references, and public and government Internet sites were conducted.

STUDY SELECTION: All articles and additional references from those articles were thoroughly evaluated.

DATA SYNTHESIS: Clostridium botulinum toxin blocks acetylcholine release in a dose-dependent fashion, resulting in acute symmetric diplopia, dysarthria, dysphonia, dysphagia, and possible neurologic sequelae despite the route of exposure (i.e., food-borne, wound, intestinal, inhalation). Disease secondary to genetically engineered C. botulinum may differ from that of inadvertent exposure. Present treatment is primarily supportive care, respiratory support, rapid decontamination, and antitoxin administration (i.e., trivalent, pentavalent, heptavalent antitoxin). Early initiation of antitoxin limits the extent of paralysis, but does not reverse it.

CONCLUSIONS: Supportive care and the use of antitoxin have been effective in the treatment of botulism from food-borne, intestinal, and wound exposure. However, the effectiveness of antitoxin in the treatment of inhaled C. botulinum has not been proven.

Key Words: botulism, Clostridium botulinum

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