title: Role of intravenous immune globulin in streptococcal toxic shock syndrome and Clostridium difficile infection.
abstract: OBJECTIVE
  The use of intravenous immune globulin (IVIG) in the management of streptococcal toxic shock syndrome (STSS) and Clostridium difficile infection (CDI) is reviewed.
  
  
  CONCLUSIONS
  IVIG has a wide range of uses in clinical practice, including STSS and CDI. It is an attractive option for these two infections because both infections are toxin mediated, and IVIG may contain antibodies that neutralize these toxins. For STSS and CDI, IVIG is often considered for use in critically ill patients who are not responding to traditional therapies. Several encouraging case reports and retrospective chart reviews have been published, highlighting the potential benefit of IVIG in such patients. However, its definitive role remains unclear, mainly due to the lack of high-level evidence. Data supporting its use have been extrapolated from retrospective chart reviews and case reports in which profound heterogeneity in patient populations and treatment modalities exist. The use of IVIG must be weighed carefully because it is not a benign product. As with the use of IVIG for STSS, the role of IVIG for CDI is unclear. Nonetheless, IVIG may serve as a useful adjunct therapy for patients suffering from severe complicated CDI (shock, ileus, or megacolon) who do not respond to conventional treatment. Adverse reactions to IVIG are mild and transitory and occur during or immediately after drug infusion.
  
  
  CONCLUSIONS
  Although randomized, controlled trials supporting the use of IVIG for STSS and CDI are lacking, IVIG may be considered a last-line adjunct therapy in those patients for whom the clinical benefit outweighs the potential adverse effects of therapy.
authors.affiliation: Punit J. Shah, Pharm.D., BCPS, is Antimicrobial Stewardship Pharmacist, Alexian Brokers Health System, Elk Grove Village, IL; at the time of writing he was Antimicrobial Utilization Review Pharmacist, Cedars-Sinai Medical Center, Los Angeles, CA. Niyati Vakil, Pharm.D., BCPS, is Antimicrobial Utilization Review Pharmacist, Pharmacy Services, Cedars-Sinai Medical Center. Anna Kabakov, Pharm.D., BCPS, is Assistant Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Clinical Pharmacy Specialist, Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL; at the time of writing she was Clinical Pharmacy Specialist, Internal Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL. pjdshah@gmail.com.
authors.forename: Punit J
authors.initials: PJ
authors.lastname: Shah
authors.affiliation: Punit J. Shah, Pharm.D., BCPS, is Antimicrobial Stewardship Pharmacist, Alexian Brokers Health System, Elk Grove Village, IL; at the time of writing he was Antimicrobial Utilization Review Pharmacist, Cedars-Sinai Medical Center, Los Angeles, CA. Niyati Vakil, Pharm.D., BCPS, is Antimicrobial Utilization Review Pharmacist, Pharmacy Services, Cedars-Sinai Medical Center. Anna Kabakov, Pharm.D., BCPS, is Assistant Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Clinical Pharmacy Specialist, Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL; at the time of writing she was Clinical Pharmacy Specialist, Internal Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL.
authors.forename: Niyati
authors.initials: N
authors.lastname: Vakil
authors.affiliation: Punit J. Shah, Pharm.D., BCPS, is Antimicrobial Stewardship Pharmacist, Alexian Brokers Health System, Elk Grove Village, IL; at the time of writing he was Antimicrobial Utilization Review Pharmacist, Cedars-Sinai Medical Center, Los Angeles, CA. Niyati Vakil, Pharm.D., BCPS, is Antimicrobial Utilization Review Pharmacist, Pharmacy Services, Cedars-Sinai Medical Center. Anna Kabakov, Pharm.D., BCPS, is Assistant Professor, Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Clinical Pharmacy Specialist, Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL; at the time of writing she was Clinical Pharmacy Specialist, Internal Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL.
authors.forename: Anna
authors.initials: A
authors.lastname: Kabakov
mesh_terms: D000818:Animals; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology
chemical_list: D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors