Botulism Antitoxin (Equine)
Class: Antitoxins and Immune Globulins
Brands: BAT
Introduction
Antitoxin; heptavalent preparation of equine immunoglobulin F(ab′)2 and F(ab′)2-related fragments capable of neutralizing botulinum neurotoxins A, B, C, D, E, F, and G. Other botulism antitoxin (equine) preparations containing antibody to fewer botulinum neurotoxins (e.g., bivalent botulinum antitoxin AB, monovalent botulinum antitoxin E) were previously available in the US and may be available elsewhere.
Uses for Botulism Antitoxin (Equine)
Treatment of Botulism
Treatment of symptomatic botulism following documented or suspected exposure to botulinum neurotoxin serotypes A, B, C, D, E, F, or G; designated an orphan drug by FDA for treatment of botulism.
Botulism is a potentially fatal neuroparalytic illness characterized by acute afebrile, symmetric, descending, flaccid paralysis. Caused by neurotoxin produced by Clostridium botulinum; certain strains of C. argentinense, C. baratii, and C. butyricum also can produce neurotoxin and cause botulism. C. botulinum spores are ubiquitous in the environment in soil and water sediments and can germinate into the vegetative bacteria that produce toxin. There are 7 known serotypes of botulinum toxin (A, B, C, D, E, F, G) and all cause similar disease; naturally occurring human botulism usually involves serotypes A, B, E, and F.
Foodborne botulism occurs following ingestion of food contaminated with botulinum toxin (e.g., improperly canned food); symptoms usually begin 12–48 hours (range: 2 hours to 10 days) after ingestion. Wound botulism occurs following contamination of wounds with C. botulinum spores from the environment that then germinate and produce botulinum toxin; time between wound contamination and onset of symptoms usually is 4–14 days. Infant botulism occurs when infants <1 year of age ingest C. botulinum spores that then germinate, colonize the GI tract, and produce botulinum toxin; time between exposure and onset of symptoms estimated to be 3–30 days. Intestinal botulism (child or adult) occurs following intestinal colonization with C. botulinum and subsequent production of botulinum toxin.
Botulism also could potentially occur from iatrogenic overdose or misinjection of commercially available botulinum toxin used therapeutically (e.g., abobotulinumtoxinA, incobotulinumtoxinA, onabotulinumtoxinA, rimabotulinumtoxinB) or from inhalation of aerosolized botulinum toxin (e.g., in the context of biologic warfare or bioterrorism). Symptoms of botulism may be evident within 12–72 hours following an inhalation exposure.
Botulism Antitoxin (Equine) Dosage and Administration
General
Administer botulism antitoxin (equine) heptavalent as soon as possible after clinical diagnosis of botulism (ideally within 24 hours after onset of symptoms); use in conjunction with intensive supportive care (e.g., respiratory, fluid, and nutritional support).
Do not delay treatment of bot...
