Equine botulinum antitoxin for the treatment of infant botulism

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

CLINICAL AND VACCINE IMMUNOLOGY

AMER SOC MICROBIOLOGY

Lugar: Washington DC; Año: 2011 vol. 18 p. 1845 - 1849

1556-6811

Infant botulism is the most common form of human botulism in Argentina and the United States. 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 botulinum antitoxin (EqBA) as an alternative treatment. 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. 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=0.0155), 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. These results suggest that prompt treatment of infant botulism with EqBA is safe and effective and EqBA could be considered as an alternative specific treatment for infant botulism when BabyBIG® is not available.