This article in the Drug and Therapeutics Bulletin (DTB) assesses the evidence on the efficacy of intravenous human normal immunoglobulin (IVIG) in the following infectious diseases:

• Severe invasive group A streptococcal disease
• Staphylococcal toxic shock syndrome
• Necrotising (PVL-associated) Staphylococcus aureus sepsis
• Clostridium difficile colitis
• Post-transplantation CMV pneumonitis
• Sepsis syndrome and septic shock

Supply problems, Department of Health (DH) guidance, adverse effects and cost, are also addressed.

The article concludes that while the DH’s advice on rational use of IVIG “appears reasonable and pragmatic, it is also important to recognise the poverty of evidence to justify use of IVIG for any of the above indications, and published evidence does not support the use of IVIG in the treatment or prevention of sepsis.”