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


METHODS
Searches of MEDLINE (1966-November 2001), tertiary references, and public and government Internet sites were conducted.


METHODS
All articles and additional references from those articles were thoroughly evaluated.


RESULTS
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.
Robinson
Renee F
RF
Pediatric Pharmacotherapy, College of Pharmacy, Ohio State University, Columbus, OH 43210-1291, USA.
Nahata
Milap C
MC
D000992:Antitoxins / Q000627:therapeutic use; D023482:Bioterrorism; D001905:Botulinum Toxins / Q000276:immunology; D001906:Botulism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003666:Decontamination; D005517:Foodborne Diseases; D006801:Humans; D017053:Infection Control
D000992:Antitoxins; D001905:Botulinum Toxins