Treatment of Clostridium botulinum infections

Treatment

Treatment of botulism involves (a) initial supportive therapy, (b) neutralizing unbound toxin by specific antitoxins, and (c) stopping toxin production by use of antibiotics.

Antitoxin therapy: A trivalent A-B-E botulinum antitoxinserum is used for specific treatment of botulism. The sera con-tain antibodies against C. botulinum types A, B, and E, which act by binding and neutralizing the toxins present in the serum. The trivalent botulinum antitoxin is administered immediately in patients who are symptomatic with high clinical suspicion of food-borne botulism and wound botulism. Antitoxin is useful, even when given several weeks after toxin ingestion, because circulating toxin has been detected in serum as long as 4 weeks later. Nevertheless, antitoxins do not neutralize toxin already bound to neuromuscular junctions. Although antitoxin can slow disease progression, it has no effect on established neurologic pathology.

Antibiotics therapy: Antibiotics are used to prevent mul-tiplication of C. botulinum in the gastrointestinal tract and in the wound, thus halting production and release of toxins. Metronidazole is the current antimicrobial drug of choice with penicillin as an alternative treatment.