Strategies to Mitigate Infection Risk in Patients Receiving Complement Inhibitor Therapy

Prevention of encapsulated bacterial infection is critical for safe systemic treatment with complement inhibitors. Gaps in provider awareness and practical clinical guidance remain. In this narrative review, we highlight key aspects of how the complement inhibitors' mechanisms of action might theoretically increase the risk of infection, summarize current evidence-based recommendations, provide expert opinion to fill in the gaps in these recommendations, identify critical unanswered questions, and suggest studies to address them. Following recommendations for vaccinations and antibiotic prophylaxis are key approaches for preventing serious infections from encapsulated bacteria (especially meningococci) in patients using complement inhibitors to treat kidney or eye diseases. The duration of antibiotic prophylaxis remains a provider-dependent decision because of the lack of evidence to support more specific recommendations. Consultations with infectious disease specialists regarding local bacterial resistance/sensitivity patterns may inform the choice of agents for antibiotic prophylaxis. Patients with worrisome signs or symptoms must be promptly evaluated.