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Antibiotics are not indicated in the treatment of infant botulism. Human Botulism Immune Globulin (BabyBIG) and supportive care are the treatment.

Infant botulism occurs when a infant ingests Clostridium botulinum spores. These spores go on to germinate in the large intestines and produce botulinum toxin. Botulinum toxin prevents the release of acetylcholine into the neuromuscular junction leading to the typical symptoms of acute (hours to days) onset of cranial nerve palsies, and descending hypotonia.

References:

American Academy of Pediatrics. Botulism and Infant Botulism. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2018;