title: Medical treatment for botulism.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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).
  
  
  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.
authors.affiliation: Medicine and Neurology & Neurosurgery, McGill University, Montreal General Hospital - Room L7-313, 1650 Cedar Avenue, Montreal, Quebec, Canada, H3G 1A4.
authors.forename: Colin
authors.initials: C
authors.lastname: Chalk
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Benstead
authors.forename: Mark
authors.initials: M
authors.lastname: Keezer
mesh_terms: D001906:Botulism / Q000628:therapy*; D003014:Clostridium botulinum; D006760:Hospitalization; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007223:Infant; D016032:Randomized Controlled Trials as Topic
chemical_list: D007136:Immunoglobulins; C068584:botulism immune globulin