Infant Botulism: an alternative treatment is possible?

VANELLA E, PIOVANO ML, FERNANDEZ RA, SARTORI O, L DE JONG LIT, BIANCO MI, PERALTA MB, CORREA AP

Buenos Aires, Argentina

Congreso; 6° Congreso Mundial de Infectología Pediátrica; 2009

Aims: Human Botulism Immune Globulin Intravenous (BIG-IV) is the drug of choice for treatment of infant botulism. However, its high cost per treatment ($ 45,300) severely limits its use in many countries. As an alternative, we assessed the effectiveness and safety of equine botulism antitoxin (EqBA).Methods: This retrospective, multi-institutional, open-labeled study included 57 laboratory-confirmed cases of infant botulism demanding intensive care and mechanical ventilation (from January 1, 1993, to December 31, 2008). Thirty five infants were treated with EqBA within 5 days after the onset of signs while 22 infants did not receive EqBA. Analysis was performed with Statistix version 7.0®, (Analytical Software, PO Box 12185, Tallahassee, FL 32317). A Student´s t test for non-paired data was used for quantitative continuous variables and Proportions with Fisher´s exact test. Results: Infants treated with EqBA had a reduction in mean length of hospital stay of 19.3 days (40%; P= 0.003). Intensive care was shortened by 11.7 days (39%; P= 0.005), mechanical ventilation by 11.7 days (44%; P= 0.006) and tube feeding by 20.9 days (44%; P= 0.0007). Additionally, the incidence of sepsis was 50% lower (P= 0.0001). Neither sequelae nor adverse effects attributable to EqBA were noticed, except for an infant who developed a transient erythematous rash.Conclusions: Prompt treatment of infant botulism with EqBA was safe and effective in shortening the length of hospital stay and attenuating the severity of the disease. These results suggest that EqBA should be considered as an alternative treatment for infant botulism when BIG-IV is not available