Botulinum antitoxin

Indications

Botulinum antitoxin is used for: Botulism, Antitoxin indicated for naturally occurring noninfant botulism

Adult Dose

Botulism Antitoxin indicated for naturally occurring noninfant botulism IV solution 20 mL (1 vial) IV infusion; dilute further with 0.9% NaCl to 1:10 ratio before administering

Child Dose

Renal Dose

Administration

Administer slowly by IV infusion via volumetric infusion pump; minimize allergic reactions by starting at 0.5 mL/min for initial 30 minutes If no infusion-related reaction, may increase to 1 mL/min IV for next 30 minutes, then if no reaction evident, may increase to 2 mL/min for remainder of infusion IV Preparation Thaw frozen antitoxin in water bath at 37C (99F) Prepare infusion under aseptic conditions Avoid foaming; do NOT shake vial Visually assess for particulate matter and discoloration Do not use unless solution is clear, nonturbid, and without particulate matter Dilute 1:10 in 0.9% NaCl for injection May store premixed IV bag refrigerated; use within 8-10 hr IV Administration In-line filter optional; pore size no smaller than 15 microns (smaller pore size may slow infusion rate) Administer slowly by IV infusion via volumetric infusion pump; minimize allergic reactions by starting at 0.5 mL/min for initial 30 minutes If no infusion-related reaction, may increase to 1 mL/min IV for next 30 minutes, then if no reaction evident, may increase to 2 mL/min for remainder of infusion Epinephrine, diphenhydramine, and intubation capabilities must be immediately available to treat anaphylaxis

Contra Indications

No absolute contraindications identified in individual with high-risk exposure to botulinum toxin

Precautions

Allergic reactions are expected to be infrequent Immediate systemic reactions (allergic reactions, shock, anaphylaxis) can occur whenever an equine product is administered; immediate reaction usually occurs within 30 minutes after initiating infusion Infuse IV slowly as described under administration in adult dosing section Milder allergic reactions (eg, mild bronchoconstriction, hypotension, hives) may be more common

Pregnancy-Lactation

Pregnancy Category: C; experience limited in pregnant women; however, A, B and E antitoxins have been given to pregnant women without causing harm to the mother or the fetus Being pregnant is not a reason to avoid H-BAT administration for botulism; benefit to the mother and the fetus from receiving heptavalent botulinum antitoxin should be weighed against risk of harm from treatment; decisions should be made on a case-by-case basis by treating physician Lactation: Unknown whether distributed in breast milk

Interactions

Adverse Effects

Side effects of Botulinum antitoxin : Investigational IND, adverse drug reactions unknown

Mechanism of Action

Equine derived antitoxin that elicits passive antibody (ie, immediate immunity) against Clostridium botulinum toxins A, B, C, D, E, F, and G