Guanidine in Botulism

To the Editor.—  A recent article by Puggiari and Cherington, "Botulism and Guanidine: Ten Years Later" (240:2276, 1978), reported on two additional cases of botulism treated with guanidine hydrochloride. The authors noted improved strength of ocular and limb muscles but not of respiratory muscles. They then reviewed the literature and noted that "some benefit" was reported in 39 cases and "little or no benefit" was shown in 13 others treated with guanidine. Contributing to these figures, but not directly called to the reader's attention by citation, was an important article by Faich et al,¹ "Failure of Guanidine Therapy in Botulism A." This article cites one of the more careful and complete studies on the value, or rather, the nonvalue, of guanidine. Faich and associates stressed in their conclusion that they could find "no objective or subjective clinical benefits from guanidine therapy... [in their four cases] during the acute or recovery