SUPPORTIVE PENTOXIFYLLINE IN FALCIPARUM-MALARIA - NO EFFECT ON TUMOR-NECROSIS-FACTOR-ALPHA LEVELS OR CLINICAL OUTCOME - A PROSPECTIVE, RANDOMIZED, PLACEBO-CONTROLLED STUDY

Pentoxifylline (POF) may suppress overproduction of tumor necrosis fac tor alpha (TNF alpha), which is thought to contribute to complications of human falciparum malaria. However, POF is believed to improve impa ired capillary blood flow, which can be impaired in falciparum malaria . To test whether POF affects TNF alpha serum levels or other variable s in this disease, we administered POF (20 mg/kg/day intravenously in 150 mi of saline for five days) randomized versus placebo (150 ml of s aline without POF) in addition to standard antimalarial therapy. After recruitment of 51 patients with Plasmodium falciparum malaria, those receiving POF had more nausea and abdominal discomfort than the placeb o group, as expected. Eleven of 27 patients receiving POF and three of 24 patients receiving placebo requested termination of the study medi cation (P < 0.05). Pentoxifylline did not change the decrease of TNF a lpha levels or affect the clinical course in a significant way. Since POF failed to improve the clinical situation or to impact numerous lab oratory parameters (including TNF alpha, thrombin-antithrombin III, th rombomodulin, and human neutrophil elastase), the study was terminated earlier than planned. While this study does not specifically address cerebral complications of malaria, the results suggest that POF is not useful as a routine adjunct to the standard therapy of falciparum mal aria.