What infection prophylaxis is needed prior to administering complement inhibition therapy for the treatment of paroxysmal nocturnal hemoglobinuria (PNH)?

Updated: May 20, 2021
  • Author: Emmanuel C Besa, MD; Chief Editor: Sara J Grethlein, MD, FACP  more...
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Consequences of complement inhibition include an increased risk of infections from Neisseria meningitides, as seen in inherited terminal complement deficiency. [9] Before the administration of eculizumab or ravulizumab, all patients should be vaccinated with a serogroup B meningococcal vaccine. [50] Alashkar et al suggest that serologic response testing after vaccination is warranted, because immunological response to vaccines varies, and that re-vaccination with a tetravalent conjugate vaccine every 3 years is essential, or should be based on response rates, in patients on eculizumab therapy. [51]

Despite vaccination, patients may develop meningococcal septicemia (not meningitis). Although this is rare, occurring at a rate of 0.5 cases per 100-patient years, prophylactic antibiotics are recommended to prevent this complication. One study used penicillin V, 500 mg twice daily orally, or erythromycin 500 mg twice daily for patients intolerant to penicillin. [52]

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