Immunoglobulin Therapy of Sepsis

D.V. Maltsev


Approbation of immunoglobulin therapy in sepsis was based on the concept of antimicrobial, antiinflammatory and immunomodulatory effects of antibodies. Immunoglobulin preparations are being used in septic pathology at least in two ways — directly for sepsis management and suppression of manifestations of systemic inflammatory response and to prevent this complication in specific high-risk groups, such as premature infants with hypoimmunoglobulinemia. Currently, three kinds of immunoglobulin preparations were tested: multivalent immunoglobulin, containing almost exclusively IgG, immunoglobulin enriched with IgM and IgA, and monoclonal specific immunoglobulins, particularly antibodies to endotoxin. Most evidence base is accumulated for IgG-containing polyvalent immunoglobulin, however, it seems that each of the formulations has advantages in certain subgroups of patients.
The availability in Ukraine of monocomponent multivalent IgG-containing intravenous immunoglobulin Octagam produced by Swiss company Octapharma lets be optimistic about the therapy of patients in need of this type of treatment. Octagam distinguishes good tolerability proved in the 11-year prospective observational study [101], a high degree of viral safety [101] and comfortable conditions of storage (from +2 to +25 °C) [102]. In addition, the maximum rate of Octagam administration is 0.08 ml/kg/min [102], which makes the drug irreplaceable in situations when rapid initiation of therapy is need.
At the moment, immunoglobulin is positioned as a second-line agent for the treatment of sepsis in unfavourable course of the pathological process, high risk of death and multiresistance of microorganism to antimicrobial chemotherapy. However, immunoglobulin still has vast therapeutic niches in septic patients. We are talking about the separate subgroups of patients, in whom it is appropriate to use immunoglobulin as a first-line drug for bacterial sepsis along with antibiotic therapy. This are the persons with streptococcal necrotizing fasciitis and toxic shock, pregnant women, children infected with HIV, patients with toxic epidermal necrolysis or autoimmune complications, in which the efficacy of immunoglobulin therapy was proved, as well as immunocompromised patients with primary and secondary hypo- or disimmunoglobulinemia.


sepsis; immunoglobulin; immunotherapy; Octagam


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