Wednesday, August 10, 2011

Role of IV immunoglobulin in sepsis

Sepsis is the inflammatory response of the body to severe infection, which can be caused by a variety of bacteria. Deaths due to sepsis and septic shock remain high despite giving antibiotics, especially if the lungs, heart and kidney are affected.

Intravenous immunoglobulin preparations contain antibodies that help the body to neutralize bacterial toxins.
There are two types of preparations, polyclonal immunoglobulins contain several antibodies and monoclonal immunoglobulins target a specific antigen.
The cochrane reviews found 24 trials of polyclonal immunoglobulins, with 17 in adults (1958 participants) and seven in newborn infants (338 participants); 18 trials (a total of 13,413 participants) were of monoclonal antibodies.
Both standard and IgM-enriched polyclonal immunoglobulins decreased the number of deaths in adults but not in infants.
In the monoclonal immunoglobulin trials, anti-endotoxin antibodies showed no benefit while the anti-cytokines showed a very small reduction in deaths among adults with sepsis.
h The reduction in deaths observed with polyclonal preparations needs to be confirmed in large studies that use high quality methods.
Most of the trials were small and the totality of the evidence is insufficient to support a robust conclusion of benefit. Adjunctive therapy with monoclonal IVIGs remains experimental.

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