Page 1194 - Basic _ Clinical Pharmacology ( PDFDrive )

1180 SECTION X Special Topics

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TABLE A–3 Materials available for passive immunization.
Indication Product Dosage Comments
Black widow Antivenin (Latrodectus One vial (6000 units) IV or IM. Some For persons with hypertensive cardiovascular disease
spider bite mactans), equine patients may require a repeat dose. or aged <16 or >60 years.
Bone marrow Immune globulin (intra- 500 mg/kg IV on days 7 and 2 prior to Prophylaxis to decrease the risk of infection, intersti-
transplantation venous [IV]) 2 transplantation and then once weekly tial pneumonia, and acute graft-versus-host disease
through day 90 after transplantation. in adults undergoing bone marrow transplantation.
Botulism Botulism antitoxin hep- Consult the CDC. 3 Treatment of symptomatic botulism. Available from
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tavalent equine, Types the CDC. Incidence of serum reactions is <1%.
A–G
Botulism immune 75 mg/kg IV. For the treatment of patients <1 year of age with
globulin (IV) infant botulism caused by toxin type A or B.
Chronic Immune globulin (IV) 2 400 mg/kg IV every 3–4 weeks. Dosage CLL patients with hypogammaglobulinemia and a
lymphocytic should be adjusted upward if bacterial history of at least one serious bacterial infection.
leukemia (CLL) infections occur.
Cytomegalovi- Cytomegalovirus Consult the manufacturer’s dosing Prophylaxis of CMV infection in bone marrow, kidney,
rus (CMV) immune globulin (IV) recommendations. liver, lung, pancreas, and heart transplant recipients.
Diphtheria Diphtheria antitoxin, 20,000–100,000 units IV or IM Early treatment of respiratory diphtheria. Available
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equine depending on the severity and duration from the CDC. Anaphylactic reactions in ≥7% of
of illness. adults and serum reactions in ≥5–10% of adults.
Hepatitis A Immune globulin (intra- Preexposure prophylaxis: 0.02 mL/kg Preexposure and postexposure hepatitis A
muscular [IM]) IM for anticipated risk of ≥3 months, prophylaxis. The availability of hepatitis A vac-
0.06 mL/kg for anticipated risk of cine has greatly reduced the need for preexposure
>3 months, repeated every 4–6 months prophylaxis. Patients >40 years should receive
for continued exposure. hepatitis A vaccine in addition to immune globulin
for postexposure prophylaxis
Postexposure: 0.02 mL/kg IM as soon as
possible after exposure up to 2 weeks.
Hepatitis B Hepatitis B immune 0.06 mL/kg IM as soon as possible after Postexposure prophylaxis in nonimmune persons
globulin (HBIG) exposure up to 1 week for percutaneous following percutaneous, mucosal, sexual, or perinatal
exposure or 2 weeks for sexual expo- exposure. Hepatitis B vaccine should also be
sure. 0.5 mL IM within 12 hours after administered.
birth for perinatal exposure.
HIV-infected Immune globulin (IV) 2 400 mg/kg IV every 28 days. HIV-infected children with recurrent serious bacterial
children infections or hypogammaglobulinemia.
Idiopathic Immune globulin (IV) 2 Consult the manufacturer’s dosing Response in children with ITP is greater than in
thrombocyto- recommendations for the specific adults. Corticosteroids are the treatment of choice in
penic purpura product being used. adults, except for severe pregnancy-associated ITP.
(ITP)
Kawasaki Immune globulin (IV) 2 400 mg/kg IV daily for 4 consecutive Effective in the prevention of coronary aneurysms.
disease days within 4 days after the onset of For use in patients who meet strict criteria for
illness. A single dose of 2 g/kg IV over Kawasaki disease.
10 hours is also effective.
Measles Immune globulin (IM) Normal hosts: 0.25 mL/kg IM. Postexposure prophylaxis (within 6 days after
exposure) in nonimmune contacts of acute cases.
Immunocompromised hosts: 0.5 mL/kg
IM (maximum 15 mL for all patients).
Primary immu- Immune globulin (IV) 2 Consult the manufacturer’s dosing Primary immunodeficiency disorders include specific
nodeficiency recommendations for the specific antibody deficiencies (eg, X-linked agammaglobulin-
disorders product being used. emia) and combined deficiencies (eg, severe
combined immunodeficiencies).
Rabies Rabies immune 20 IU/kg. The full dose should be Postexposure rabies prophylaxis in persons not
globulin infiltrated around the wound and any previously immunized with rabies vaccine. Must be
remaining volume should be given IM combined with rabies vaccine.
at an anatomic site distant from vaccine
administration.
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