Intravenous Immunoglobulin for the Treatment of Clostridium difficile Infection: A Review

Abougergi, Marwan S.; Kwon, John H.

doi:10.1007/s10620-010-1411-2

Cited by 83 publications

(53 citation statements)

References 59 publications

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“…Th us, there has been interest in immune approaches to treat both severe (refractory) and recurrent RCDI. Publications to date on IVIG to treat RCDI in humans include six case reports and six small case series with varied patient inclusions (severe and recurrent), ages, doses of therapy used, and duration of therapy among other parameters ( 124,125 ). Many patients also received concomitant standard therapy, making interpretation of effi cacy diffi cult.…”

Section: Treatment Of ≥ 3 CDI Recurrencesmentioning

confidence: 99%

“…Passive immunizations with IVIG have been reported to be successful in several small series, including both children and adults. A recent review concluded that the grade of evidence is weak, given the lack of RCTs ( 125 ). One exception may be patients with hypogammaglobulinemia, which is common in patients following solid organ transplants, and may predispose to CDI.…”

Section: Treatment Of ≥ 3 CDI Recurrencesmentioning

confidence: 99%

See 1 more Smart Citation

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,477

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Section: Treatment Of ≥ 3 CDI Recurrencesmentioning

confidence: 99%

Section: Treatment Of ≥ 3 CDI Recurrencesmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,477

1,408

View full text Add to dashboard Cite

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“…In an early case series of five children with relapsing CDI and low antitoxin antibody levels, intravenous immunoglobulin (IVIG) treatment resulted in resolution of their symptoms in association with an increase in antitoxin antibody levels (Leung et al, 1991). Since that time, IVIG has been used to treat many cases of severe or refractory CDI with mixed results (Abougergi et al, 2010;O'Horo & Safdar, 2009;Wilcox, 2004). Different doses of IVIG (150-400 mg kg 21 ) administered at varying frequencies (one to three doses), with or without adjunctive treatment with oral anti-C. difficile antibiotics, have produced varying results.…”

Section: The Need To Target Both Toxin a And B For Effective Immunothmentioning

confidence: 99%

“…Likewise, there is no standardized algorithm for its use. Most recently, Abougergi et al (2010) reported a high mortality rate (57 %) in 21 patients treated with IVIG for severe CDI. The authors found that higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores on the day of IVIG infusion were significantly associated with higher mortality.…”

Section: The Need To Target Both Toxin a And B For Effective Immunothmentioning

confidence: 99%

The host immune response to Clostridium difficile

Kelly

Kyne

2011

Journal of Medical Microbiology

167

146

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“…There are no randomized controlled trials showing a benefit of IVIG for CDI [Abougergi et al 2010]. It is believed that the mechanism of action for IVIG may include the presence of antibodies against C. difficile toxin A and toxin B Abougergi and Kwon, 2011].…”

Section: Other Medication Regimensmentioning

confidence: 99%

Clostridium difficile infection: management strategies for a difficult disease

Khanna

Pardi

2013

Therap Adv Gastroenterol

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Clostridium difficile was first described as a cause of diarrhea in 1978 and in the last three decades has reached an epidemic state with increasing incidence and severity in both healthcare and community settings. There also has been a rise in severe outcomes from C. difficile infection (CDI). There have been tremendous advancements in the field of CDI with the identification of newer risk factors, recognition of CDI in populations previously thought not at risk and development of better diagnostic modalities. Several treatment options are available for CDI apart from metronidazole and vancomycin, and include new drugs such as fidaxomicin and other options such as fecal microbiota transplantation. This review discusses the epidemiology, risk factors and outcomes from CDI, and focuses primarily on existing and evolving treatment modalities.

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Intravenous Immunoglobulin for the Treatment of Clostridium difficile Infection: A Review

Cited by 83 publications

References 59 publications

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

The host immune response to Clostridium difficile

Clostridium difficile infection: management strategies for a difficult disease

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