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IV Ig ineffective treatment for children with streptococcal toxic shock syndrome
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Adjunctive intravenous immunoglobulin therapy increased treatment costs but did not improve outcomes among children with streptococcal toxic shock syndrome, results from a study indicated.
"This multicenter study is, to our knowledge, the largest to describe the epidemiology and outcomes of children with streptococcal toxic shock syndrome and the first to explore the association between IV Ig use and clinical outcomes," the researchers wrote.
Retrospective analyses of 192 children with streptococcal toxic shock syndrome who were admitted to 36 participating hospitals revealed the following:
- Differences in mortality rates among the 84 IV Ig recipients and the 108 nonrecipients were not statistically significant.
- Patients treated with IV Ig had longer median hospital (14 days vs. seven days) and ICU stays (six days vs. three days; P<.001) compared with those who were not administered the therapy.
- Total hospital costs, including drug supply, lab, clinical and other expenses, were higher among patients administered IV Ig with a median cost of $43,546 compared with $15,520 among patients not administered IV Ig.
Similarities in mortality rates between the two pediatric groups in this study were discordant with previously observed eightfold higher odds of survival among IV Ig recipients in an observational study that involved adults, according to the researchers. They noted that the conflicting results may relate to concurrent treatment with clindamycin — although the antibiotic was administered "almost routinely" among the pediatric patients, many non-IV Ig recipients in the adult group were not assigned to the drug.
"The concurrent use of clindamycin therapy may improve outcomes to such an extent that detection of any additional benefit conferred by IV Ig would require prohibitively large numbers of study participants," the researchers wrote.
They also suggested that the clinical benefits of IV Ig may depend on early administration, which may be difficult in clinical practice.
Shah SS. Clin Infect Dis. 2009;49:1369-1376.