CBRNE - Botulism Medication

Updated: Feb 23, 2023
  • Author: Peter P Taillac, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
  • Print

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. [18]


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.


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.