Administration of either product must be given in an MTF where personnel and equipment are available to treat possible anaphylaxis. Repeat this dose until there is no more improvement. For patients with positive skin tests, attempt desensitization by subcutaneously administering 0.01 to 0.1 ml of antitoxin, gradually increase the dose every 20 minutes until 2.0 cc can be sustained without a marked reaction. Preferably, desensitization should be performed by an experienced allergist. NOTE Aminoglycosides and clindamycin may further impair neuromuscular transmission and may lead to clinical deterioration if used for patients with botulism.
Botulism can result in severe morbidity.
Complications include descending paralysis, with possible respiratory failure. Case fatality is approximately 60 percent without respiratory intensive care. However, with respiratory supportive care, prognosis is favorable, with case fatality rates at approximately 5 percent. Recovery may be prolonged, requiring up to three months for signs of initial improvement and up to one year for complete symptomatic recovery. Psychological sequelae may be severe and require specific interventions.