Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock
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 performance of people's vital organs such as the lungs, heart and kidney are affected. Several studies have looked into other agents to help the body fight the effects of sepsis. 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. This updated review 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. No reductions in deaths of adults or infants were seen with polyclonal IVIG using high quality trials only. 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. The polyclonal immunoglobulin trials were small compared to the trials of monoclonal preparations. The reduction in deaths observed with polyclonal preparations needs to be confirmed in large studies that use high quality methods.
Alejandria, M. M.; Lansang, M. A. D.; Dans, L. F.; Mantaring III, J. B. Intravenous immunoglobulin for treating sepsis, severe sepsis and septic shock. Cochrane Database of Systematic Reviews 2002, Issue 1, Art. No.: CD001090. [DOI: 10.1002/14651858.CD001090]