Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism: A Systematic Review and Meta-analysis of Cases, 1923-2016

John C. O'Horo, Eugene P. Harper, Abdelghani El Rafei, Rashid Ali, Daniel C. Desimone, Amra Sakusic, Omar M. Abu Saleh, Jasmine R. Marcelin, Eugene M. Tan, Agam K. Rao, Jeremy Sobel, Pritish K. Tosh

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

Background. Botulism is a rare, potentially severe illness, often fatal if not appropriately treated. Data on treatment are sparse. We systematically evaluated the literature on botulinum antitoxin and other treatments. Methods. We conducted a systematic literature review of published articles in PubMed via Medline, Web of Science, Embase, Ovid, and Cumulative Index to Nursing and Allied Health Literature, and included all studies that reported on the clinical course and treatment for foodborne botulism. Articles were reviewed by 2 independent reviewers and independently abstracted for treatment type and toxin exposure. We conducted a meta-analysis on the effect of timing of antitoxin administration, antitoxin type, and toxin exposure type. Results. We identified 235 articles that met the inclusion criteria, published between 1923 and 2016. Study quality was variable. Few (27%) case series reported sufficient data for inclusion in meta-analysis. Reduced mortality was associated with any antitoxin treatment (odds ratio [OR], 0.16; 95% confidence interval [CI], .09.30) and antitoxin treatment within 48 hours of illness onset (OR, 0.12; 95% CI, .03.41). Data did not allow assessment of critical care impact, including ventilator support, on survival. Therapeutic agents other than antitoxin offered no clear benefit. Patient characteristics did not predict poor outcomes. We did not identify an interval beyond which antitoxin was not beneficial. Conclusions. Published studies on botulism treatment are relatively sparse and of low quality. Timely administration of antitoxin reduces mortality; despite appropriate treatment with antitoxin, some patients suffer respiratory failure. Prompt antitoxin administration and meticulous intensive care are essential for optimal outcome.

Original languageEnglish (US)
Pages (from-to)S43-S56
JournalClinical Infectious Diseases
Volume66
DOIs
StatePublished - Dec 27 2017

Fingerprint

Antitoxins
Botulism
Meta-Analysis
Therapeutics
Critical Care
Botulinum Antitoxin
Odds Ratio
Confidence Intervals
Mortality
Mechanical Ventilators
PubMed
Respiratory Insufficiency
Nursing

Keywords

  • antitoxin
  • botulism
  • systematic review

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism : A Systematic Review and Meta-analysis of Cases, 1923-2016. / O'Horo, John C.; Harper, Eugene P.; El Rafei, Abdelghani; Ali, Rashid; Desimone, Daniel C.; Sakusic, Amra; Abu Saleh, Omar M.; Marcelin, Jasmine R.; Tan, Eugene M.; Rao, Agam K.; Sobel, Jeremy; Tosh, Pritish K.

In: Clinical Infectious Diseases, Vol. 66, 27.12.2017, p. S43-S56.

Research output: Contribution to journalReview article

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 2017, 'Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism: A Systematic Review and Meta-analysis of Cases, 1923-2016', Clinical Infectious Diseases, vol. 66, pp. S43-S56. https://doi.org/10.1093/cid/cix815
O'Horo, John C. ; Harper, Eugene P. ; El Rafei, Abdelghani ; Ali, Rashid ; Desimone, Daniel C. ; Sakusic, Amra ; Abu Saleh, Omar M. ; Marcelin, Jasmine R. ; Tan, Eugene M. ; Rao, Agam K. ; Sobel, Jeremy ; Tosh, Pritish K. / Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism : A Systematic Review and Meta-analysis of Cases, 1923-2016. In: Clinical Infectious Diseases. 2017 ; Vol. 66. pp. S43-S56.
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abstract = "Background. Botulism is a rare, potentially severe illness, often fatal if not appropriately treated. Data on treatment are sparse. We systematically evaluated the literature on botulinum antitoxin and other treatments. Methods. We conducted a systematic literature review of published articles in PubMed via Medline, Web of Science, Embase, Ovid, and Cumulative Index to Nursing and Allied Health Literature, and included all studies that reported on the clinical course and treatment for foodborne botulism. Articles were reviewed by 2 independent reviewers and independently abstracted for treatment type and toxin exposure. We conducted a meta-analysis on the effect of timing of antitoxin administration, antitoxin type, and toxin exposure type. Results. We identified 235 articles that met the inclusion criteria, published between 1923 and 2016. Study quality was variable. Few (27{\%}) case series reported sufficient data for inclusion in meta-analysis. Reduced mortality was associated with any antitoxin treatment (odds ratio [OR], 0.16; 95{\%} confidence interval [CI], .09.30) and antitoxin treatment within 48 hours of illness onset (OR, 0.12; 95{\%} CI, .03.41). Data did not allow assessment of critical care impact, including ventilator support, on survival. Therapeutic agents other than antitoxin offered no clear benefit. Patient characteristics did not predict poor outcomes. We did not identify an interval beyond which antitoxin was not beneficial. Conclusions. Published studies on botulism treatment are relatively sparse and of low quality. Timely administration of antitoxin reduces mortality; despite appropriate treatment with antitoxin, some patients suffer respiratory failure. Prompt antitoxin administration and meticulous intensive care are essential for optimal outcome.",
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T2 - A Systematic Review and Meta-analysis of Cases, 1923-2016

AU - O'Horo, John C.

AU - Harper, Eugene P.

AU - El Rafei, Abdelghani

AU - Ali, Rashid

AU - Desimone, Daniel C.

AU - Sakusic, Amra

AU - Abu Saleh, Omar M.

AU - Marcelin, Jasmine R.

AU - Tan, Eugene M.

AU - Rao, Agam K.

AU - Sobel, Jeremy

AU - Tosh, Pritish K.

PY - 2017/12/27

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N2 - Background. Botulism is a rare, potentially severe illness, often fatal if not appropriately treated. Data on treatment are sparse. We systematically evaluated the literature on botulinum antitoxin and other treatments. Methods. We conducted a systematic literature review of published articles in PubMed via Medline, Web of Science, Embase, Ovid, and Cumulative Index to Nursing and Allied Health Literature, and included all studies that reported on the clinical course and treatment for foodborne botulism. Articles were reviewed by 2 independent reviewers and independently abstracted for treatment type and toxin exposure. We conducted a meta-analysis on the effect of timing of antitoxin administration, antitoxin type, and toxin exposure type. Results. We identified 235 articles that met the inclusion criteria, published between 1923 and 2016. Study quality was variable. Few (27%) case series reported sufficient data for inclusion in meta-analysis. Reduced mortality was associated with any antitoxin treatment (odds ratio [OR], 0.16; 95% confidence interval [CI], .09.30) and antitoxin treatment within 48 hours of illness onset (OR, 0.12; 95% CI, .03.41). Data did not allow assessment of critical care impact, including ventilator support, on survival. Therapeutic agents other than antitoxin offered no clear benefit. Patient characteristics did not predict poor outcomes. We did not identify an interval beyond which antitoxin was not beneficial. Conclusions. Published studies on botulism treatment are relatively sparse and of low quality. Timely administration of antitoxin reduces mortality; despite appropriate treatment with antitoxin, some patients suffer respiratory failure. Prompt antitoxin administration and meticulous intensive care are essential for optimal outcome.

AB - Background. Botulism is a rare, potentially severe illness, often fatal if not appropriately treated. Data on treatment are sparse. We systematically evaluated the literature on botulinum antitoxin and other treatments. Methods. We conducted a systematic literature review of published articles in PubMed via Medline, Web of Science, Embase, Ovid, and Cumulative Index to Nursing and Allied Health Literature, and included all studies that reported on the clinical course and treatment for foodborne botulism. Articles were reviewed by 2 independent reviewers and independently abstracted for treatment type and toxin exposure. We conducted a meta-analysis on the effect of timing of antitoxin administration, antitoxin type, and toxin exposure type. Results. We identified 235 articles that met the inclusion criteria, published between 1923 and 2016. Study quality was variable. Few (27%) case series reported sufficient data for inclusion in meta-analysis. Reduced mortality was associated with any antitoxin treatment (odds ratio [OR], 0.16; 95% confidence interval [CI], .09.30) and antitoxin treatment within 48 hours of illness onset (OR, 0.12; 95% CI, .03.41). Data did not allow assessment of critical care impact, including ventilator support, on survival. Therapeutic agents other than antitoxin offered no clear benefit. Patient characteristics did not predict poor outcomes. We did not identify an interval beyond which antitoxin was not beneficial. Conclusions. Published studies on botulism treatment are relatively sparse and of low quality. Timely administration of antitoxin reduces mortality; despite appropriate treatment with antitoxin, some patients suffer respiratory failure. Prompt antitoxin administration and meticulous intensive care are essential for optimal outcome.

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