Botulism Antitoxin, Heptavalent
Mechanism :
It comprises of polyclonal antibody fragments against the neurotoxin produced by clostridium botulinum, thus blocking its action. It provides passive immunity against the following toxins produced by botulinum - A to G. Equine derived antitoxin that elicits passive antibody (ie, immediate immunity) against Clostridium botulinum toxins.
Indication :
Contraindications :
• Hypersensitivity
• Asthma
• Allergies
• History of hypersensitivity to horses/horse serum
• Shock
• Anaphylaxis
• Benefits outweigh risk in using antitoxin in pregnancy and lactation hence can be used for protecting the mother and fetus. Final decision regarding use should be made on case to case basis.
• A, B and E antitoxins have been given to pregnant women without causing harm to the mother or the fetus
Dosing :
Dosage forms:
IV solution (injection): 20 ml vial.
For acute botulism:
<1 year: start with 0.01 ml/kg/min IV over 30 minutes, 10% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min.
1-16 years:
10-14 kg: start with 0.01ml/kg/min IV over 30 minutes, 20% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
15·19 kg: start with 0.D 1ml/kg/min IV over 30 minutes, 30% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
20-24 kg: start with 0.D1ml/kg/min IV over 30 minutes, 40°/o of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
25-29 kg: start with 0.D1 ml/kg/min IV over 30 minutes, 50% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
30-34 kg: start with 0.D1 ml/kg/min IV over 30 minutes, 60% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
35-39 kg: start with 0.01 ml/kg/min IV over 30 minutes, 65% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
40-44 kg: start with 0.D1 ml/kg/min IV over 30 minutes, 70% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
45-49 kg: start with 0.D1 ml/kg/min IV over 30 minutes, 75% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
50-54 kg: start with 0.5 ml/min IV over 30 minutes, 80% of 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
>55 kg: start with 0.5 ml/min IV over 30 minutes, 1 vial. May increase by 0.01ml/kg/min every 30 minutes upto maximum dose of 0.03 ml/kg/min or 2 ml/min.
17 years or older: start with 0.5ml/min IV over 30 minutes, 1 vial. May double the rate every 30 minutes upto maximum dose of 2 ml/min.
In case of hypersensitivity risk, always start at lowest possible rate of infusion.
Adverse Effect :
• Common: headache, itching/pruritis, rash/redness, hives, nausea
• Uncommon: chills, fever, throat discomfort
• Rare: chest pain/tightness in chest, cough, dyspnea, feeling of discomfort, increased sweating, light headedness/dizziness, fainting, unconsciousness, unusual tiredness, fast irregular pulse, reduced blood pressure, stopping of heart, arthritis, myalgia, swollen lymph nodes
Hepatic Dose :
• Not defined for pediatric population