Figure 1.

Immunoglobulin replacement therapy (IGRT) initiation assessment pathway. The Figure shows an outline assessment pathway for patients presenting with hypogammaglobulinaemia with a requirement to integrate clinical and laboratory findings and, where appropriate, to determine the impact of a trial of antibiotics. It is important to be able to reassess a decision if there is a change in the clinical or laboratory picture and to evaluate the effect of introduction of antibiotics or IGRT. Infection burden is a multi‐dimensional concept, which is difficult to condense into a number, but as a guide for adults a minimal infection burden would represent viral infections not requiring antibiotics and two or less 1‐week courses of oral antibiotics in 12 months. The pathway is a simplified outline of a complex area where clinical experience and judgement is required for each individual case to optimize care.