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Oral pentoxifylline as a novel adjunct to standard therapy in pediatric community-acquired pneumonia: a randomized
Rehab Elmeazawy1, Manal Zaki AbdElsamea2, Amany Barakat2
1Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt. rehab.elmeazawy@med.tanta.edu.eg.
Insights
Pentoxifylline (PTX) significantly improved outcomes for children hospitalized with community-acquired pneumonia (CAP). This adjunctive therapy reduced inflammation and accelerated lung healing, offering a new approach to pediatric pneumonia treatment.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Infectious Diseases
Background:
- Community-acquired pneumonia (CAP) is a leading cause of childhood illness and mortality globally.
- Persistent inflammation and lung injury can prolong recovery in pediatric CAP patients despite antibiotic treatment.
- Oral pentoxifylline (PTX) was investigated as an adjunct therapy to standard care for hospitalized children with CAP.
Purpose of the Study:
- To evaluate the efficacy of oral pentoxifylline (PTX) in combination with standard antibiotic and supportive therapies for treating hospitalized children with CAP.
- To assess the impact of PTX on clinical, laboratory, and radiological parameters in pediatric CAP patients.
Main Methods:
- A randomized controlled trial involving 106 children with CAP.
- Participants were assigned to receive either oral PTX plus standard therapy or standard therapy alone.
- Treatment response was evaluated using clinical criteria, laboratory markers, and lung ultrasound at baseline and after 10 days.
Main Results:
- The PTX group showed significantly lower respiratory rates and higher oxygen saturation compared to controls.
- Laboratory markers indicated reduced inflammation and improved nutritional status in the PTX group (e.g., lower CRP, IL-6, higher hemoglobin).
- Lung ultrasound demonstrated fewer affected lung zones, better resolution of B-lines, and smaller pleural effusions in the PTX group.
Conclusions:
- Adjunctive oral pentoxifylline significantly improved clinical status in children hospitalized with CAP.
- PTX treatment led to a reduction in systemic inflammation and enhanced radiological resolution of lung injury.
- This study provides the first randomized controlled trial evidence for the effectiveness of oral pentoxifylline as an adjunct therapy in pediatric pneumonia.
Background:
Pneumonia remains a major cause of childhood illness and death globally, especially in low- and middle-income countries. Despite antibiotic therapy, persistent inflammation and lung injury may delay recovery. This study aimed to evaluate the efficacy of oral pentoxifylline (PTX), combined with standard antibiotic and supportive therapies, for treating hospitalized children with Community-acquired pneumonia (CAP).
Methods:
In this randomized controlled trial, 106 children with CAP were randomly assigned to receive either oral pentoxifylline plus standard antibiotic and supportive therapy (n = 53) or standard therapy alone (n = 53), per institutional guidelines. Treatment response was evaluated using predefined clinical criteria (respiratory rate and oxygen saturation), laboratory parameters (hemoglobin, WBC count, CRP, interleukin-6, LDH, D-dimer, serum albumin, and liver enzymes), and lung ultrasound findings, assessed at baseline and after 10 days of treatment.
Results:
The mean age of enrolled patients was 5.61 ± 3.31 years, and 45.3% were female. After 10 days, the PTX group demonstrated significantly lower respiratory rates (29.17 ± 4.38 vs. 34.02 ± 8.29 breaths/min; p < 0.001) and higher oxygen saturation (97.28 ± 1.32% vs. 96.26 ± 1.55%; p < 0.001) compared with controls. Laboratory improvements in the PTX group included higher hemoglobin and serum albumin and lower WBC count, AST, total bilirubin, CRP, LDH, IL-6, and D-dimer levels (all p < 0.05). Lung ultrasound revealed fewer affected lung zones (3.81 ± 1.75 vs. 5.71 ± 2.14; p < 0.001), greater resolution of confluent B-lines (88.7% vs. 71.7%), and smaller pleural effusions (0.94 ± 0.60 cm vs. 1.65 ± 0.90 cm; p < 0.01).
Conclusion:
Adjunctive oral pentoxifylline improved clinical status, reduced systemic inflammation, and enhanced radiological resolution in children hospitalized with CAP.
Clinical Trial Registration:
At ClinicalTrials.gov (Identifier: NCT06265389). First submitted and met quality control criteria on February 11, 2024; first posted publicly on February 19, 2024. https://clinicaltrials.gov/study/NCT06265389 .
Impact:
Many children with community-acquired pneumonia experience delayed recovery despite effective antibiotic therapy due to persistent inflammation and lung injury. This is the first randomized controlled trial to evaluate the effectiveness of oral pentoxifylline as an adjunct therapy in pediatric pneumonia. Adjunctive oral pentoxifylline improved clinical outcomes, reduced systemic inflammation, and accelerated lung healing.
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