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Prophylactic Antibiotics Versus Immunoglobulin Replacement in Specific Antibody Deficiency

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Abstract

Purpose

Prophylactic antibiotics (PA) and immunoglobulin replacement (IGRT) are commonly used in specific antibody deficiency (SAD); however, optimal treatment is not well-established. Our purpose is to compare treatment outcomes with IGRT and/or PA among SAD patients.

Methods

A retrospective chart review of SAD patients treated at two tertiary centers between January 2012 and May 2017 was performed. Clinical and laboratory data, and rates of infections prior to and after treatment with IGRT or PA were analyzed. Descriptive analyses, between-group comparisons of rates of infection after 1 year of treatment, and a stepwise logistic regression model were employed to explore factors contributing to treatment outcomes.

Results

We identified 65 SAD patients with mean age were 18 years (2–71 years). The baseline mean number of infections in the PA group and IGRT group was 4.71 (SD 3.15) and 7.73 (SD 6.65), respectively. Twenty-nine (44.6%) received IGRT, 7 (10.7%) received PA, 7 (10.7%) received both IGRT and PA, 15 (23.1%) failed PA and switched to IGRT, and 7 did not receive any specific treatment. After 1 year of treatment, the difference in the mean number of infections in PA vs. IGRT was not statistically significant [2.86 (2.73) vs. 4.44 (4.74), p = 0.27]. Reporting autoimmunity increased the odds for persistent infections (OR = 4.29; p = 0.047), while higher IgG levels decreased the odds for persistent infections (OR = 0.68, p = 0.018).

Conclusions

PA and IGRT are equally effective as first line in preventing infections in SAD patients. However, patients who fail PA would benefit from IGRT.

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Abbreviations

SAD:

Specific antibody deficiency

PA:

Prophylactic antibiotics

IGRT:

Immunoglobulin replacement therapy

TCH:

Texas Children’s Hospital

CHOP:

Children’s Hospital Philadelphia

PID:

Primary immunodeficiency

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Acknowledgments

The research is partially supported by the Jeffery Modell Foundation, and supported in part by the Intramural Research Program of the NIH, NIAID. Joud Hajjar received the USIDnet and the Clinical immunology society travel grants for an oral presentation summarizing this work.

Authorship Contributions

Conceptualization: [Joud Hajjar]; Methodology: [Joud Hajjar], Formal analysis and investigation: [Joud Hajjar, Carleigh Kutac, An Nguyen, Gregory Constantine, Maha Syed and Kathleen Sullivan], Writing—original draft preparation: [Joud Hajjar, Maha Syed]; Writing—review and editing: [all authors]; Supervision: [Joud Hajjar, Jordan Orange and Kathleen Sullivan].

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Authors and Affiliations

  1. Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Baylor College of Medicine, Section of Immunology, 1102 Bates St. FC 330, Houston, TX, 77030, USA

    Joud Hajjar, Carleigh Kutac & Maha N. Syed

  2. The William T Shearer Center for Human Immunobiology at Texas Children’s Hospital, Houston, TX, USA

    Joud Hajjar, Carleigh Kutac & Maha N. Syed

  3. Vitality Allergy, Houston, TX, USA

    An L. Nguyen

  4. National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA

    Gregory Constantine

  5. Department of Pediatrics, Vagelos College of Physicians and Surgeons Columbia University, New York, NY, USA

    Jordan S. Orange

  6. Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Kathleen E. Sullivan

Authors
  1. Joud Hajjar
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  2. An L. Nguyen
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  3. Gregory Constantine
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  4. Carleigh Kutac
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  6. Jordan S. Orange
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  7. Kathleen E. Sullivan
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Correspondence to Joud Hajjar.

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Joud Hajjar, Nguyen, A.L., Constantine, G. et al. Prophylactic Antibiotics Versus Immunoglobulin Replacement in Specific Antibody Deficiency. J Clin Immunol 40, 158–164 (2020). https://doi.org/10.1007/s10875-019-00716-2

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  • DOI: https://doi.org/10.1007/s10875-019-00716-2

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