Inspection of the intranasal septum and paranasal sinuses also may disclose a focus of C. botulinum infection in persons who snort cocaine. Both risk for death and duration of hospitalization can be reduced by prompt administration of botulinal antitoxin. Antitoxin is not contraindicated in pregnancy. Wounds suspected of being contaminated with C. botulinum should be widely debrided and irrigated, ideally after the administration of the antitoxin. Penicillin, 10-20 million units per day, is considered the antibiotic of choice, although its efficacy has not been determined.
Mechanical ventilation is the main supportive therapy for treatment of severe botulism.
We can arrange through the Washington State Department of Health to obtain botulinal antitoxin if it is indicated. Vaccination histories for GBS cases were obtained from providers. Vaccination-associated cases were defined as those having onset of GBS within six weeks of vaccination because prior studies established that all or almost all the elevated risk occurred in this time frame. Influenza vaccine coverage in the general population was estimated for the study periods using a telephone survey. Influenza vaccination in the six weeks prior to onset of GBS was confirmed for 19 of 180 cases of GBS identified and with vaccination history available.