Pentoxifylline in perforated peritonitis: Results of a randomised, placebocontrolled trial

Objectives: To evaluate the role of pentoxifylline as an adjuvant to operat ion and routine antibiotic treatment for perforated peritonitis. Design: Randomised controlled clinical trial. Settings: University hospital, India. Subjects: 36 patients with clinically diagnosed and radiologically confirme d perforated peritonitis. 22 (61%) had typhoid enteric perforations, 11 (31 %) had duodenal ulcer perforations while 3 (8%) had perforated gastric ulce rs. Intervention: Laparotomy with closure of perforation and lavage together wi th routine antibiotic treatment (ciprofloxacin and metronidazole), and rand om allocation to pentoxifylline 200 mg/day for 3 days in 500 ml of saline o ver 3-4 hours or saline alone (n = 18 in each group). Main outcome measures: Hospital stay, APACHE II scores, and the condition o f the wound during the postoperative period. Results: The baseline characteristics of the two groups were essentially si milar. However, their preoperative APACHE Il scores differed significantly (mean (SD) 12 (3) in the pentoxifylline group compared with 10 (2) in the s aline group; p <0.01). The outcome was better in the pentoxifylline group i n terms of significantly reduced hospital stay (median 8, range 6-17, compa red with 11, 7-27, p = 0.02) improved postoperative APACHE 11 scores (mean (SD) 8 (2) compared with 9 (2), p = 0.02), and reduced incidence of wound i nfection (6/18 compared with 12/18, p = 0.02). Conclusion: The addition of pentoxifylline to our standard management proto col for patients with perforated peritonitis helped to improve their outcom e significantly compared with a placebo-treated group.