Dg. Remick et al., PENTOXIFYLLINE FAILS TO PREVENT THE JARISCH-HERXHEIMER REACTION OR ASSOCIATED CYTOKINE RELEASE, The Journal of infectious diseases, 174(3), 1996, pp. 627-630
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.