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Pentoxifylline as a supportive agent in the treatment of cerebral malaria in children
G Di Perri1, I G Di Perri, G B Monteiro
1Institute of Immunology, University of Verona, Italy.
Insights
Pentoxifylline significantly reduced coma duration in children with cerebral malaria (CM). This malaria treatment showed a trend towards lower mortality, suggesting a potential therapeutic role for pentoxifylline in CM management.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Cerebral malaria (CM) is a severe complication of malaria.
- Tumor necrosis factor (TNF) is implicated as a mediator in CM pathogenesis.
Purpose of the Study:
- To evaluate the efficacy of pentoxifylline as an adjunct therapy in children with cerebral malaria.
- To investigate the effect of pentoxifylline on tumor necrosis factor (TNF) synthesis in CM patients.
Main Methods:
- An open, randomized, controlled therapeutic trial involving 56 children with CM.
- Children received standard quinine regimen with or without pentoxifylline (10 mg/kg/day IV infusion).
- Coma duration and mortality rates were primary outcome measures; TNF serum levels were monitored.
Main Results:
- Pentoxifylline administration significantly shortened coma duration (median 6 hours vs. 46 hours; P < .001).
- A trend towards lower mortality was observed in the pentoxifylline group (P = .055).
- Reduced TNF serum levels were noted in some pentoxifylline recipients, correlating with better outcomes.
Conclusions:
- Pentoxifylline demonstrated a significant benefit in reducing coma duration in pediatric cerebral malaria.
- The drug may modulate TNF production, a key factor in CM.
- Larger, double-blind trials are necessary to confirm the therapeutic role of pentoxifylline in cerebral malaria.
Abstract:
In an open, randomized, controlled therapeutic trial, 56 children with cerebral malaria (CM) were randomly assigned to receive standard quinine regimen with or without pentoxifylline (10 mg/kg/day by continuous intravenous infusion). Pentoxifylline exerted an inhibitory effect on the synthesis of tumor necrosis factor (TNF), a possible mediator of CM. The 26 children who received pentoxifylline had significantly shorter comas than controls (median, 6 vs. 46 h; P < .001) Pentoxifylline recipients showed a trend toward a lower mortality, with a borderline significant difference (P = .055). The better outcome in the pentoxifylline group was associated with a decline in TNF serum levels on the third day of treatment in a few subjects that was not seen in controls. While alternative or concurrent mechanisms of action may be of some relevance, larger double-blind trials are needed to determine whether pentoxifylline has a therapeutic role in CM.