Intravenous Immunoglobulin for the Treatment of Severe, Refractory, and Recurrent Clostridium difficile Diarrhea

McPherson, Stuart; Rees, Colin; Ellis, Richard J.; Soo, Shelly; Panter, Simon

doi:10.1007/s10350-006-0511-8

Cited by 181 publications

(81 citation statements)

References 20 publications

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“…Toxinreactive IgG and IgA can be detected in the intestine and serum and have the potential to block toxin binding to epithelial receptors and promote toxin clearance from the intestine (71). The presence of antibodies that are reactive to C. difficile TcdA has been positively correlated with asymptomatic carriage of C. difficile (32), although there are conflicting reports regarding whether naturally occurring antitoxin antibodies and intravenous immunoglobulin therapy (IVIG) affect the disease course (32,69,70,(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83). Questions thus remain as to the extent to which antibody levels may confer protection against CDI.…”

Section: Risk Factors For Developing CDImentioning

confidence: 99%

Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies

et al. 2017

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SUMMARY Beneficial microorganisms hold promise for the treatment of numerous gastrointestinal diseases. The transfer of whole microbiota via fecal transplantation has already been shown to ameliorate the severity of diseases such as Clostridium difficile infection, inflammatory bowel disease, and others. However, the exact mechanisms of fecal microbiota transplant efficacy and the particular strains conferring this benefit are still unclear. Rationally designed combinations of microbial preparations may enable more efficient and effective treatment approaches tailored to particular diseases. Here we use an infectious disease, C. difficile infection, and an inflammatory disorder, the inflammatory bowel disease ulcerative colitis, as examples to facilitate the discussion of how microbial therapy might be rationally designed for specific gastrointestinal diseases. Fecal microbiota transplantation has already shown some efficacy in the treatment of both these disorders; detailed comparisons of studies evaluating commensal and probiotic organisms in the context of these disparate gastrointestinal diseases may shed light on potential protective mechanisms and elucidate how future microbial therapies can be tailored to particular diseases.

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Section: Risk Factors For Developing CDImentioning

confidence: 99%

Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies

et al. 2017

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“…Other approaches attempting to treat refractory CDI have included the use of intravenous immunoglobulin (IVIG) administration, pulsed and tapering doses of vancomycin, vancomycin plus rifampin, probiotics (lactobacilli and Saccharomyces boulardii) and a C. difficile toxoid vaccine. 17,23,91,130,[132][133][134][135][136] Another successful approach appears to be the use of fecal transplants. This procedure involves the reconstitution of patient gut flora from a donor sample, usually administered via nasogastric tube.…”

Section: Interventions and Future Studiesmentioning

confidence: 99%

Clostridium difficileinfection

2010

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“…There are several reported cases of successful treatment with intravenous tigecycline, alone or in combination with vancomycin [3]. Other authors demonstrated that intravenous immunoglobulins might also contribute to the improvement of these patients if given in addition to oral vancomycin [4].…”

Section: Discussionmentioning

confidence: 99%

“…Despite existing guidelines, there is no defined protocol for treating severe refractory CDI, and literature data comes from individual case reports with different treatment approaches. Intravenous tygecyclin, intravenous immunoglobulins, oral vancomycin in higher doses, and vancomycin enema are some of the suggested treatment regimens but they were all applied to a small number of patients [3][4][5][6]. Oral teicoplanin is another antibiotic, which was proven to be successful in the treatment of patients with CDI, including those with severe disease [7,8].…”

Section: Introductionmentioning

confidence: 99%

Oral teicoplanin for successful treatment of severe refractory Clostridium difficile infection

Popović¹,

Korać²,

Nesic

et al. 2015

J Infect Dev Ctries

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Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin. Methodology: A one-year prospective study was carried out in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia. Patients with severe and complicated CDI who failed to respond to oral vancomycin and intravenous metronidazole combination therapy were enrolled. They were given oral teicoplanin 100 mg bi-daily. Patients were followed for recurrence for eight weeks. Results: Nine patients with a mean age of 70.8±9.4 years were analyzed. All patients had pseudomembranous colitis, and five had complicated disease. In four patients intracolonic delivery of vancomycin was also performed in addition to oral vancomycin and intravenous metronidazole prior to initiating teicoplanin, but without improvement. After teicoplanin initiation all patients achieved clinical cure. The mean time to resolution of diarrhoea after teicoplanin introduction was 6.3±4.5 days. There was no statistically significant difference in time to resolution of diarrhoea according to initial leucocyte count, age over 65 years, the presence of ileus, complicated disease and the use of concomitant antibiotic therapy (p = 0.652, 0,652, 0.374, 0.374, and 0,548, respectively). None of the patients experienced recurrence. Conclusions: Oral teicoplanin might be a potential treatment for severe and complicated refractory CDI, but further studies are required.

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Intravenous Immunoglobulin for the Treatment of Severe, Refractory, and Recurrent Clostridium difficile Diarrhea

Abstract: Intravenous immunoglobulin may be effective for severe, refractory, or recurrent Clostridium difficile diarrhea after failed conventional treatment.

Cited by 181 publications

References 20 publications

Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies

Gleaning Insights from Fecal Microbiota Transplantation and Probiotic Studies for the Rational Design of Combination Microbial Therapies

Clostridium difficileinfection

Oral teicoplanin for successful treatment of severe refractory Clostridium difficile infection

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