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CBRNE - Botulism Medication

  • Author: Peter P Taillac, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
 
Updated: Apr 21, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Medication commonly used in the treatment of botulism is described below. In addition to that described, guanethidine and 4-aminopyridine have been used for the treatment of botulinum paralysis but have not been shown to be effective.

The use of local antibiotics such as penicillin G or metronidazole may be helpful in eradicating Clostridium botulinum in wound botulism. Antibiotic use is not recommended for infant botulism because cell death and lysis may result in the release of more toxin. Aminoglycoside antibiotics and tetracyclines, in particular, may increase the degree of neuromuscular blockade by impairing neuronal calcium entry.

Current research into pharmacotherapy has mainly focused on small molecules, peptides, and peptidomimetics that inhibit botulism neurotoxin light chain proteolytic activity. However, a few drug candidates have reached clinical evaluation. Potential new treatment targets include botulism neurotoxin uptake and processing inhibitors, enzymatic inhibitors, as well as modulators of neuronal processes associated with toxin clearance, neurotransmitter potentiation, and other pathways involved in neuronal recovery and repair.[8]

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Antitoxin therapy

Class Summary

Therapy consists of antibodies against toxin types A, B, C, D, E, F, and G to neutralize serum toxin concentrations.

Botulinum antitoxin, heptavalent (HBAT)

 

Investigational antitoxin indicated for naturally occurring noninfant botulism. Equine-derived antitoxin that elicits passive antibody (ie, immediate immunity) against Clostridium botulinum toxins A, B, C, D, E, F, and G.

Each 20-mL vial contains equine-derived antibody to the 7 known botulinum toxin types (A through G) with the following nominal potency values: 7500 U anti-A, 5500 U anti-B, 5000 U anti-C, 1000 U anti-D, 8500 U anti-E, 5000 U anti-F, and 1000 U anti-G.

Available from CDC as treatment IND protocol. Replaces licensed bivalent botulinum antitoxin AB (BAT-AB) and investigational monovalent botulinum antitoxin E (BAT-E). To obtain, contact CDC Emergency Operations Center; telephone: (770) 488-7100.

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Immune Globulin

Class Summary

Consists of administration of immunoglobulin pooled from serum or plasma of immunized subjects.

Botulism immune globulin IV

 

For infant botulism, IV Human Botulinum Immune Globulin (BIG-IV or BabyBIG) trials in California were completed in early 1997; trials demonstrated safety and efficacy of human-derived botulinum immune globulin and a reduced mean hospital stay from 5.5 wk to 2.5 wk.

BIG-IV is now FDA approved and is only available from the California Department of Health Services (24-h telephone: 510-540-2646).

Solvent-detergent treated and viral screened immune globulin is derived from pooled adult plasma from persons immunized with botulinum toxoid that developed high neutralizing antibody titers against botulinum neurotoxins type A and B. Indicated to treat infant botulism (age < 1 y) caused by type A or B C botulinum.

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Contributor Information and Disclosures
Author

Peter P Taillac, MD Clinical Professor of Surgery, Division of Emergency Medicine, University of Utah Health Sciences Center

Peter P Taillac, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Kim, MD Chairman, Department of Emergency Medicine, Western Medical Center; Clinical Instructor, University of California, Irvine, School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Barry J Sheridan, DO Chief Warrior in Transition Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Duane C Caneva, MD, MSc Senior Medical Advisor to Customs and Border Protection, Department of Homeland Security (DHS) Office of Health Affairs; Federal Co-Chair, Health, Medical, Responder Safety Subgroup, Interagency Board (IAB)

Disclosure: Nothing to disclose.

Additional Contributors

Edward Bessman, MD, MBA Chairman and Clinical Director, Department of Emergency Medicine, John Hopkins Bayview Medical Center; Assistant Professor, Department of Emergency Medicine, Johns Hopkins University School of Medicine

Edward Bessman, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Courtesy of Arnon SS, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA 2001 Apr 25;285:1059.
 
 
 
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