[What therapeutic possibilities exist in acute antibiotic-resistant and chronic infections]

Since the rate of mortality in severe sepsis could not be changed in the last years even not by sophisticated antibiotics, and since the mutants of bacteria resistant to antibiotics are permanently increasing, other possibilities must be taken into considerations to prevent or to treat infections. The improvement of the patient's own immune resistance by active or passive immunizations seems to be a cooperative or alternative way to overcome severe and chronic infections. In animal experiments the efficacy of gammaglobulin treatment of a severe infection was tested. The positive result i.e. improvement of the mortality from 75% to 45%, stimulated to a controlled clinical study, in which severe infected patients were additionally treated with gammaglobulin and compared with those without gammaglobulin treatment. Patients with gammaglobulin treatment showed a much better outcome of their infection than control patients. The rate of infections as well as time of hospital stay and other clinical and laboratory parameters were markedly improved in gammaglobulin-treated patients. Also the principle of active immunization was tested in animal experiments. Guinea pigs were orally vaccinated with heat inactivated pathogenic bacteria. In a following challenge infection vaccinated animals survived in a high percentage whereas control animals died. This success in vaccinating animals did lead to a controlled clinical study with patients suffering from chronic bone infection. Patients were treated orally with heat inactivated bacteria over a time of 8 weeks. Not only laboratory data indicating an improved immune response were changed by the treatment but also the clinical findings. These results indicate clearly that infections can be treated not only by attacks against bacteria but also by the improvement of the patient's own bacterial resistance.