Medication Summary

Antibiotics are useful in wound botulism, but they have no role in foodborne botulism.

Class Summary

When botulism develops following a wound infection, antibiotic therapy and meticulous debridement of the wound are essential.

Penicillin G (Pfizerpen)

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Preferred drug of choice for wound botulism. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Chloramphenicol (Chloromycetin)

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Alternate to penicillin. Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria.

Clindamycin (Cleocin)

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Alternative to penicillin. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Class Summary

These agents are essential in the treatment of foodborne botulism and wound botulism. Heptavalent antitoxin (toxins A through G) is available at the Centers for Disease Control and Prevention (CDC). The CDC phone number is (770) 488-7100. Twenty percent of patients experience some degree of serum sickness or hypersensitivity reaction, and anaphylaxis can also occur. Patients who react to a test dose must be desensitized. Because of the risk of adverse reactions, prophylactic antitoxin is not recommended in patients who are exposed to botulism toxin but who have no symptoms. These patients may undergo gastric lavage or induced vomiting in an attempt to eliminate the toxin prior to absorption.

Botulinum antitoxin, heptavalent (HBAT)

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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.

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. Product to be stored in Strategic National Stockpile for emergency preparedness and responses.

Follow-up

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