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July 20, 1979, Vol 242, No. 3 >
ARTICLE | July 20, 1979

Guanidine in Botulism-Reply

Michael Cherington, MD; Marcelo Puggiari, MD
JAMA. 1979;242(3):238. doi:10.1001/jama.1979.03300030013006.
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ABSTRACT

In Reply.—  Guanidine is neither a cure for botulism nor has it helped all patients with botulism. That it has helped some patients with botulism is now documented in the world literature. In deciding whether or not to treat the patient with guanidine, the clinician might consider the following.

  1. Of the reported cases from this country and overseas, three times as many patients benefited from guanidine as those who did not.

  2. None of the botulism patients treated with guanidine suffered any irreversible side effects from the drug. The treatment time using guanidine is usually less than one month. As with any drug therapy, one must be alert to the possibility of serious side effects. If the drug is administered, one should obtain blood counts and tests of liver and renal function.

  3. Respiratory weakness remains the most resistant to reversal by guanidine. We have stressed this repeatedly in

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