EQUINE BOTULINUM ANTITOXIN FOR THE TREATMENT OF INFANT . BOTULISM

FERNÁNDEZ RA; VANELLA DE CUETOS EE; BIANCO MI; SARTORI OJ; PIOVANO ML; LÚQUEZ C; DE JONG LIT

Santa Fe, New México

Encuentro; 48th ADDual Interagency Botulism Research Coordinating Committee (IBRCC) Meeting; 2011

Interagency Botulism Research Coordinating Committee (IBRCC)

Purpose of Study: Infant botulism (IB) is an intestinal toxemia that affects infants younger than one year and it occurs usually between 2 and 24 weeks of age. IB is the most common form of human botulism in Argentina and the USA. From 1982 to 2010, Argentina reported 605 lab-confirmed cases of IB, with a mean of 39.5 cases per year in the last 10 years (2.2 per 100,000 live births). Human Botulism Immune Globulin Intravenous (BabyBIG®) is the antitoxin of choice for specific treatment of infant botulism in the United States. However, its high cost limits its use in many countries. We report here the effectiveness and safety of equine botulinun antitoxin (EqBA) as an alternative treatment. Methods Used: We conducted an analytical, observational, retrospective and longitudinal study on cases of infant botulism registered in Mendoza, Argentina from 1993 to 2007. We analyzed 92 medical records of laboratory-confirmed cases and evaluated the safety and efficacy of treatment with EqBA. Forty-nine laboratory-confirmed cases of infant botulism demanding admission in intensive care unit and mechanical ventilation: 31 treated with EqBA within the 5 days after the onset of signs and 18 untreated with EqBA. Summary of Results: EqBA-treated patients had a reduction in the mean length of hospital stay of 23.9 days (p=0.0007). For infants treated with EqBA, intensive care unit stay was shortened by 11.2 days (p=0.0036), mechanical ventilation by 11.1 days (p=0.01 55), and tube feeding by 24.4 days (p=0,0001). The incidence of sepsis in EqBA-treated patients was 47.3% lower (p=0.0017) than in the untreated ones. Neither sequelae nor adverse effects attributable to EqBA were noticed, except for one infant who developed a transient erythematous rash. Conclusions: These results suggest that prompt treatment of IB with EqBA is safe and effective and EqBA could be considered as an alternative specific treatment for IB when BabyBIG® is not available.