Pharmacology. Botulinum antitoxin contains antibodies directed against the toxins produced by the various strains of Clostridium botulinum.

1. 
   

   A new heptavalent antitoxin (H-BAT), manufactured by Cangene Corporation but accessible only through the Centers for Disease Control (CDC) via an Investigational New Drug (IND) protocol or an Emergency Use Authorization (EUA), has replaced the bivalent (A, B) and monovalent (E) forms of the antitoxin. (A pentavalent [A, B, C, D, E] toxoid is still used to vaccinate certain laboratory personnel.) H-BAT is an equine-derived antibody that covers toxin types A, B, C, D, E, F, and G. It is composed of less than 2% intact IgG and 90% or more Fab and F(ab′)2 fragments of IgG, created by enzymatic cleavage and removal of the Fc portion of the immunoglobulin.

   
   
2. 
   

   A human-derived botulism immune globulin (IgG antibodies), BabyBIG, is approved for the treatment of infant botulism caused by toxins A and B and has demonstrated significant reduction in the length of hospitalization associated with infant botulism.

   
   
3. 
   

   The antitoxins bind and inactivate only freely circulating botulinum toxins; they do not remove toxin that is already bound to nerve terminals. Because antitoxin will not reverse established paralysis once it occurs, it must be administered before paralysis sets in. Treatment within 24 hours of the onset of symptoms may shorten the course of intoxication and prevent progression to total paralysis.

Indications. H-BAT is used to treat children and adults with clinical botulism (See Botulism

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