In an adult with unexplained paresthesias suggestive of Clostridium botulinum toxin exposure, what is the recommended treatment?

Give antitoxin immediately and provide intensive supportive care. In any adult who develops unexplained paresthesias together with cranial‑nerve weakness, dysphagia, dry mouth, or descending muscle weakness, suspect botulism from Clostridium botulinum toxin and treat without delay. Administer the equine‑derived botulism antitoxin (10 000 U diluted in 100 mL normal saline, infused intravenously over 30–60 minutes) as a single dose; repeat the dose only if there is clear evidence of ongoing toxin exposure. Transfer the patient to an intensive‑care setting, monitor respiratory function (spirometry or arterial blood gases) every 2–4 hours, and intubate early if vital capacity falls below 15 mL/kg or if there are signs of respiratory fatigue. Provide mechanical ventilation as needed, maintain adequate hydration, and treat autonomic symptoms (e.g., hypertension, arrhythmias) with standard agents. For wound botulism, add appropriate antibiotics such as ampicillin‑sulbactam 3 g IV every 6 hours or metronidazole 500 mg IV every 8 hours, and perform surgical debridement of the infected tissue. In infants with suspected botulism, give human‑derived botulism immune globulin (BabyBIG) at 10 U/kg (maximum 500 U) intravenously as a single dose, and provide supportive care in a pediatric ICU. Notify local public‑health authorities promptly for epidemiologic investigation and source control. If antitoxin is unavailable or delayed, continue aggressive supportive measures and consider transfer to a center where it can be obtained.