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Question 1: In infant botulism, is equine-derived botulinum antitoxin (EqBA) an effective alternative therapy to human-derived botulinum immune globulin (BIG)?
  1. Joseph Moneim
  1. University of Cambridge School of Clinical Medicine, Cambridge, UK
  1. Correspondence to Mr. Joseph Moneim, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK; jm946{at}

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Clinical scenario

A 9-month-old child was admitted to the paediatric intensive care unit (ICU) with respiratory failure requiring ventilation for 24 hours. The child was unresponsive despite being off sedation. CT, MRI and EEG (electroencephalogram) scans were all normal, and the patient was broadly treated for sepsis, meningitis and encephalitis while investigations continued. Six days after admission, a diagnosis of infant botulism was considered and was confirmed 9 days after admission. Treatment with infant-specific antitoxin (BabyBIG) was started 11 days after admission, as it had to be ordered from California.

Earlier antitoxin administration may have reduced recovery time and improved outcomes. Equine-derived antitoxin (used in adults) is widely available and could possibly have been administered much earlier, but is the delay justified for BabyBIG due to greater effectiveness?

Clinical question

In the management of infant botulism, what is the role of equine-derived botulinum antitoxin (EqBA)?

Literature search methods

  • The Cochrane Library: botulism AND infant AND (antitoxin OR immunogloblin OR treat* OR therap*).

    • 3 reviews, 1 of which was relevant.

  • PubMed: (“botulism” (All Fields)) AND (“infant” (All Fields)) AND (“antitoxins” (MeSH Terms) OR “antitoxin” (All Fields) OR “immunoglobulins” (MeSH Terms) OR “immunoglobulin” (All Fields)) AND (recovery (All Fields) OR outcome (All Fields)) AND English (Language).

    • 22 results, 8 relevant.

  • Overall eight unique and relevant citations to be included.

The details of the …

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  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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