PENTOXIFYLLINE FAILS TO PREVENT THE JARISCH-HERXHEIMER REACTION OR ASSOCIATED CYTOKINE RELEASE

The Jarisch-Herxheimer reaction (JHR) observed after antibiotic treatm ent of relapsing fever caused by Borrelia recurrentis is associated wi th the systemic appearance of cytokines. The decrease of cytokine prod uction and block of JHR was attempted by administering pentoxifylline prior to antibiotic treatment. Fifteen patients with confirmed relapsi ng fever were infused intravenously with pentoxifylline 90 min before intramuscular injection of penicillin; 4 patients were not treated wit h pentoxifylline. All patients developed JHR to varying degrees, Treat ment with pentoxifylline failed to prevent fever, increase in pulse, r espiration, or blood pressure, or decrease in white blood cell count. No reduction of circulating levels of tumor necrosis factor, interleuk in 6, or interleukin-8 was observed with pentoxifylline treatment, Pen toxifylline did not prevent clearance of the B. recurrentis spirochete s. Thus, pentoxifylline treatment of patients with relapsing fever fai ls to prevent or diminish JHR or the associated cytokine release obser ved after appropriate antibiotic treatment.