PENTOXIFYLLINE AS AN ANCILLARY TREATMENT FOR SEVERE FALCIPARUM-MALARIA IN THAILAND

Pentoxifylline, an inhibitor of tumor necrosis factor has been evaluat ed as an antimalarial agent in combination with artesunate in 45 patie nts with severe falciparum malaria. Patients were admitted to the inte nsive care unit at the Hospital for Tropical Diseases in Bangkok, Thai land, and randomly assigned to treatment for 72 hr with a combination of intravenously administered artesunate and I) placebo, 2) low-dose p entoxifylline (0.83 mg/kg/hr), or 3) high-dose pentoxifylline (1.67 mg /kg/hr). All 45 patients had one or more manifestations of severe mala ria such as cerebral malaria (n = 18), renal failure requiring hemodia lysis (n = 9), azotemia (n = 8), jaundice (n = 25), or hyperparasitemi a Cn = 30). The overall severity was comparable in the three groups. C linical outcome was assessed with respect to the parasite clearance ti me and the fever clearance time in all patients. In addition, a number of subsidiary outcome variables were examined in specific subgroups, including the recovery time from coma for patients with cerebral malar ia, the duration of intubation in patients with respiratory distress, the number of hemodialysis treatments needed for patients with acute r enal failure, and the number of units of blood administered to patient s requiring transfusion, concentrations of tumor necrosis factor were reduced in all three groups at 48 hr after treatment, No significant d ifferences among the three treatment groups were found for any of the outcome variables examined, We conclude that the addition of pentoxify lline to artesunate therapy or severe malaria produced no evident clin ical benefit.