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 articlepeer-review

49 Scopus citations


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
StatePublished - Dec 27 2017

Bibliographical note

Funding Information:
Financial support. This work was supported in part by the National Center for Advancing Translational Sciences (grant number UL1 TR000135). J. C. O.’s time was supported by the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery at Mayo Clinic.

Publisher Copyright:
©2018 Oxford University Press.All right reserved.


  • antitoxin
  • botulism
  • systematic review


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