JAC Advance Access published online on April 8, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh176
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Microbiology, Leeds Teaching Hospitals and
University of Leeds, Old Medical School,
Leeds LS1 3EX, UK
* Corresponding author. E-mail: Mark.Wilcox{at}leedsth.nhs.uk.
Received 4 December 2003
; revised 10 February 2004
; accepted 10 February 2004
Objectives: Clostridium
difficile diarrhoea (CDD) cases treated with intravenous immunoglobulin
during a 2 year period were reviewed to determine disease severity
and response to treatment. Patients and methods: Of 580 CD cytotoxin-positive
patients, five received intravenous immunoglobulin because of protracted
and/or recurrent CDD (median duration 50 days, range 45-64);
two had biopsy- proven pseudomembranous colitis. The
five patients received a median three non-CDD antibiotic courses (range
2-8). Indices of CDD severity included hypoalbuminaemia
(n = 5, median 27 g/L, range 11-29),
marked hypokalaemia (n = 3, range 1.9-2.7
mM), markedly raised peripheral white cell count (n = 3,
18-34 x 109 cells/L), abdominal
signs (n = 3) and pyrexia (n = 1).
The five cases received metronidazole for median 17 days (range 0-63)
plus vancomycin for median 14 days (range 10-42) before
intravenous immunoglobulin. One also received rifampicin plus vancomycin
and one was given Saccharomyces boulardii. Results: Intravenous immunoglobulin was given
at a dosage of 300-500 mg/kg (most commonly 400 mg/kg) for
one dose (two patients), two doses (two patients) and in one case
for six doses. The latter patient died of intractable CDD, three
had a good therapeutic response to intravenous immunoglobulin and
CDD recurred within 6 weeks in one case. In the three successfully
treated cases, CDD resolved within 11 days. Conclusions: Intravenous immunoglobulin is useful
for the treatment of intractable and severe CDD. Controlled studies
are needed to assess the true value of this and other forms of passive
immunotherapy.
Keywords: pseudomembranous colitis, antibiotics, immunotherapy
Descriptive study of intravenous immunoglobulin
for the treatment of recurrent Clostridium difficile diarrhoea
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