Pyridostigmine for the Reversal of Severe Adverse Reactions to Botulinum Toxin in Children

J Pediatr. 2018 Mar:194:241-243. doi: 10.1016/j.jpeds.2017.11.013. Epub 2017 Dec 22.


Therapeutic botulinum toxin injections are commonly performed in pediatric otolaryngology. Aerodigestive complications from botulinum toxin injections, although rare, may be serious. Oral pyridostigmine is effective in the symptomatic treatment of these complications. We report 2 cases of aerodigestive complications arising from injection of botulinum toxin that were successfully treated with pyridostigmine.

Keywords: Botox; antidote; botulinum toxin; child; cholinesterase inhibitors; dysphagia; gastroesophageal reflux; infant; pyridostigmine; reversal; toxicity.

Publication types

  • Case Reports

MeSH terms

  • Botulinum Toxins, Type A / adverse effects*
  • Child
  • Cholinesterase Inhibitors / therapeutic use*
  • Deglutition Disorders / chemically induced
  • Deglutition Disorders / drug therapy
  • Female
  • Humans
  • Infant
  • Neuromuscular Agents / adverse effects*
  • Pyridostigmine Bromide / therapeutic use*


  • Cholinesterase Inhibitors
  • Neuromuscular Agents
  • Botulinum Toxins, Type A
  • Pyridostigmine Bromide