Editing Botulism (section)

== Treatment ==
Botulism is generally treated with botulism [[antitoxin]] and supportive care.<ref name=WHO2018/>

Supportive care for botulism includes monitoring of respiratory function. Respiratory failure due to [[paralysis]] may require [[mechanical ventilation]] for 2 to 8 weeks, plus intensive medical and nursing care. After this time, paralysis generally improves as new [[neuromuscular junction|neuromuscular connections]] are formed.<ref name=CDCClinicians>{{cite web |title=Botulism: Treatment Overview for Clinicians |publisher=U.S. Centers for Disease Control and Prevention (CDC) |date=2006 |url=http://emergency.cdc.gov/agent/Botulism/clinicians/treatment.asp |access-date=13 January 2016 |url-status=live |archive-url=https://web.archive.org/web/20160304104042/http://emergency.cdc.gov/agent/Botulism/clinicians/treatment.asp |archive-date=4 March 2016 }}</ref>

In some abdominal cases, physicians may try to remove contaminated food still in the digestive tract by inducing vomiting or using [[enema]]s. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria.<ref>{{cite journal | vauthors = Brook I | title = Botulism: the challenge of diagnosis and treatment | journal = Reviews in Neurological Diseases | volume = 3 | issue = 4 | pages = 182–9 | year = 2006 | pmid = 17224901 }}</ref>

=== Antitoxin ===
{{anchor|antitoxin}}

Botulinum antitoxin consists of [[Antibody|antibodies]] that neutralize botulinum toxin in the [[circulatory system]] by [[passive immunity|passive immunization]].<ref name="O'HoroHarper2018">{{cite journal | vauthors = O'Horo JC, Harper EP, El Rafei A, Ali R, DeSimone DC, Sakusic A, Abu Saleh OM, Marcelin JR, Tan EM, Rao AK, Sobel J, Tosh PK | title = Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism: A Systematic Review and Meta-analysis of Cases, 1923-2016 | journal = Clinical Infectious Diseases | volume = 66 | issue = suppl_1 | pages = S43–S56 | pmid = 29293927 | pmc = 5850555 | doi = 10.1093/cid/cix815 | year = 2018 }}</ref> This prevents additional toxin from binding to the neuromuscular junction, but does not reverse any already inflicted paralysis.<ref name="O'HoroHarper2018"/>

In adults, a trivalent antitoxin containing antibodies raised against botulinum toxin types A, B, and E is used most commonly; however, a [[heptavalent botulism antitoxin]] has also been developed and was approved by the U.S. [[FDA]] in 2013.<ref name="Arnon" /><ref name=FDA2013>{{cite web|title=FDA approves first Botulism Antitoxin for use in neutralizing all seven known botulinum nerve toxin serotypes|date=22 March 2013|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm345128.htm|website=FDA News Release|publisher=U.S. FDA|access-date=14 January 2016|url-status=live|archive-url=https://web.archive.org/web/20160101121905/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm345128.htm|archive-date=1 January 2016}}</ref> In infants, horse-derived antitoxin is sometimes avoided for fear of infants developing [[serum sickness]] or lasting [[hypersensitivity]] to horse-derived proteins.<ref name=deCuetos2011>{{cite journal | vauthors = Vanella de Cuetos EE, Fernandez RA, Bianco MI, Sartori OJ, Piovano ML, Lúquez C, de Jong LI | title = Equine botulinum antitoxin for the treatment of infant botulism | journal = Clinical and Vaccine Immunology | volume = 18 | issue = 11 | pages = 1845–9 | date = November 2011 | pmid = 21918119 | pmc = 3209035 | doi = 10.1128/CVI.05261-11 }}</ref> To avoid this, a human-derived antitoxin has been developed and approved by the U.S. FDA in 2003 for the treatment of infant botulism.<ref name=Arnon2006>{{cite journal | vauthors = Arnon SS, Schechter R, Maslanka SE, Jewell NP, Hatheway CL | title = Human botulism immune globulin for the treatment of infant botulism | journal = The New England Journal of Medicine | volume = 354 | issue = 5 | pages = 462–71 | date = February 2006 | pmid = 16452558 | doi = 10.1056/NEJMoa051926 | doi-access = free }}</ref> This human-derived antitoxin has been shown to be both safe and effective for the treatment of infant botulism.<ref name=Arnon2006 /><ref name=":0">{{cite journal |last1=Chalk |first1=Colin H |last2=Benstead |first2=Tim J |last3=Pound |first3=Joshua D |last4=Keezer |first4=Mark R |title=Medical treatment for botulism |journal=Cochrane Database of Systematic Reviews |date=17 April 2019 |volume=4 |issue=4 |pages=CD008123 |doi=10.1002/14651858.CD008123.pub4 |pmid=30993666 |pmc=6468196 }}</ref> However, the danger of equine-derived antitoxin to infants has not been clearly established, and one study showed the equine-derived antitoxin to be both safe and effective for the treatment of infant botulism.<ref name=deCuetos2011 />

Trivalent (A,B,E) botulinum antitoxin is derived from equine sources utilizing whole [[Antibody|antibodies]] (Fab and Fc portions). In the United States, this antitoxin is available from the local health department via the [[Centers for Disease Control|CDC]]. The second antitoxin, [[Heptavalent botulism antitoxin|heptavalent (A,B,C,D,E,F,G) botulinum antitoxin]], is derived from "despeciated" equine [[Immunoglobulin G|IgG]] antibodies which have had the Fc portion cleaved off leaving the F(ab')2 portions. This less immunogenic antitoxin is effective against all known strains of botulism where not contraindicated.<ref name="Yu2018">{{cite journal | vauthors = Yu PA, Lin NH, Mahon BE, Sobel J, Yu Y, Mody RK, Gu W, Clements J, Kim HJ, Rao AK | title = Safety and Improved Clinical Outcomes in Patients Treated With New Equine-Derived Heptavalent Botulinum Antitoxin | journal = Clinical Infectious Diseases | volume = 66 | issue = suppl_1 | pages = S57–S64 | pmid = 29293928 | pmc = 5866099 | doi = 10.1093/cid/cix816 | year = 2018 }}</ref>