Antitoxin, Supportive Care, and Adjunctive Therapies in Foodborne Botulism: A Comprehensive Systematic Review and Meta-Analysis

Background: Foodborne botulism is a rare but potentially fatal neuroparalytic illness caused by ingestion of Clostridium botulinum neurotoxins. Current treatment strategies include antitoxin administration, supportive care, and adjunctive therapies such as guanidine and 3,4-diaminopyridine. However, evidence comparing the efficacy of these interventions remain limited and inconclusive. This systematic review and meta-analysis aimed to evaluate treatment outcomes and compare the effectiveness of antitoxin, supportive care, and adjunctive therapies in managing foodborne botulism. Methods: A systematic search of PubMed and Web of Science was performed, and relevant studies were screened using predefined criteria. Data extraction and quality assessment were conducted independently by two reviewers. Pooled treatment success rates were calculated using random-effects meta-analysis with heterogeneity assessed via I² statistics. Results: 38 studies met our inclusion criteria, including case reports, case series, and observational studies. Pooled treatment success rates were high for antitoxin (95.3%, 95% CI: 91.3–97.8; p<0.001, I²=16.4%), supportive care (97.6%, 95% CI: 91.9–99.3; p<0.001, I²=0%), and guanidine (88.9%, 95% CI: 46.3–97.1; p<0.001, I²=0%). Comparative analyses showed no statistically significant differences between antitoxin alone versus combination therapy (OR 0.92, 95% CI: 0.10–8.62; p=0.94, I²=0%) or versus supportive care (OR 2.19, 95% CI: 0.28–17.14; p=0.46, I²=0%). Guanidine showed potential benefit as an adjunct, but data were limited. Conclusions: Antitoxin remains standard care for foodborne botulism, though supportive care and adjunctive treatments also show favorable outcomes. Further multicenter studies with standardized protocols are needed to optimize management.