Intravenous Human Globulin (IVIG) and Use in Sepsis

We suggest against the use of IV immunoglobulins in patients with sepsis or septic shock (weak recommendation, low quality of evidence).	Surviving Sepsis, 2016
Single administration of 15 g IVIG for one day improved the condition and inflammation earlier than divided dosage. The higher single dose might be the better within a range of approximately 15g. 1)      First,it is beneficial with regard to specific antibody replacement. We reported earlier that the outcome of a mouse overwhelming post-splenectomy infection model was improved by IVIG in a dosedependent manner of the specific antibody contained in IVIG against the etiologic agent, Streptococcus pneumoniae. We also reported that the minimum level of the specific antibody was necessary for survival. 2)      Secondly, other than the actions of specific antibodies, the beneficial actions for treatment of sepsis including immunomodulation, such as inhibition of inflammatory cytokines and neutralization of toxin, cannot be obtained unless IVIG is administered in a large amount. 3)      Thirdly, results of pharmacokinetic analyses showed that 100 mg/kg IVIG can increase blood gamma globulin concentrations lower than 200 mg/dL.The half-life of given IVIG in normal individuals is approximately three weeks, although IVIG is consumed more in septic or severe conditions and its half-life will be shorter.	Nakamura et al, 2019
Severe sepsis or septic shock , receiving a total dose regimen of 1 gram or more per kilogram of body weight , and receiving therapy for longer than 2 days were strongly associated with this survival benefit.	Turgeon et al, 2007

References

1. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016
2. Nakamura, K., Inokuchi, R., Fukushima, K., Naraba, H., Takahashi, Y., Sonoo, T., … Morimura, N. (2019). Single versus divided administration of intravenous immunoglobulin for sepsis: a retrospective and historical control study. Minerva Anestesiologica, 85(2).doi:10.23736/s0375-9393.18.12344-3 
3. Turgeon, A. F., Hutton, B., Fergusson, D. A., McIntyre, L., Tinmouth, A. A., Cameron, D. W., & Hébert, P. C. (2007). Meta-analysis: Intravenous Immunoglobulin in Critically Ill Adult Patients with Sepsis. Annals of Internal Medicine, 146(3), 193. doi:10.7326/0003-4819-146-3-200702060-00009

Prepared by Nur Nabiha R. on 26.09.2019