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Published on: December 8, 2014
Intravenous immunoglobulin therapy for severe Clostridium difficile colitis
J Salcedo1, S Keates, C Pothoulakis
1Section of Gastroenterology, Boston University School of Medicine, Massachusetts, USA.
Gut
|February 12, 1998
Summary
Intravenous immunoglobulin therapy may help severe Clostridium difficile colitis when antibiotics fail. Standard immunoglobulin preparations contain antibodies that neutralize C. difficile toxins, offering a potential passive immunotherapy option.
Area of Science:
- Medical Science
- Immunology
- Infectious Diseases
Background:
- Many individuals possess antibodies against Clostridium difficile toxins.
- An impaired antitoxin response can lead to recurrent, prolonged, or severe C. difficile-associated diarrhea and colitis.
- Standard antimicrobial therapies may be insufficient for certain severe cases.
Observation:
- Two patients with severe pseudomembranous colitis, unresponsive to metronidazole and vancomycin, were treated with intravenous immunoglobulin (IVIG).
- The study assessed the efficacy of IVIG as a potential treatment for refractory C. difficile colitis.
- Antibodies against C. difficile toxins A and B were quantified in immunoglobulin preparations.
Findings:
- Both patients receiving IVIG showed rapid clinical improvement, with resolution of diarrhea, abdominal tenderness, and distension.
- All tested immunoglobulin preparations contained IgG antibodies against C. difficile toxins A and B.
- These antibodies demonstrated in vitro neutralization of C. difficile toxins at clinically achievable IgG concentrations (0.4-1.6 mg/ml).
Implications:
- Passive immunotherapy with IVIG could be a valuable adjunct to antibiotic treatment for severe, refractory C. difficile colitis.
- Standard immunoglobulin preparations possess significant C. difficile toxin-neutralizing activity.
- IVIG administration can achieve serum IgG concentrations sufficient for effective antitoxin activity in patients with severe C. difficile colitis.
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