Intravenous immunoglobulin for prophylaxis and therapy of sepsis.

Intravenous immunoglobulins (IVIg) are widely used as prophylaxis against and as supplemental treatment of sepsis and septic shock, although this concept does not belong to the currently approved medical indications for IVIg products. A reduction in mortality by pooled IVIgGMA more than by IVIgG alone was reported in the recent Cochrane database (eight trials, 492 patients). However, the failure to reduce mortality by IVIgG in the score-based immunoglobulin treatment in sepsis study (653 patients) seriously questions whether IVIgG may reduce mortality. Patients with streptococcal toxic shock syndrome might benefit from IVIg, although it remains questionable whether large controlled trials will ever be available. Intravenous immunoglobulin prophylaxis can undoubtedly reduce the occurrence of infections-especially pneumonias-in at-risk patients. More data are necessary to ascertain whether this beneficial effect is linked with a reduction of infection-related morbidity and mortality. Ongoing studies will document whether cardiac surgery patients with escalating systemic inflammatory response syndrome or mediastinitis will benefit from IVIg. IgM-specific complement inactivation may further stimulate the discussion of IVIgGMA superiority over IVIgG.