Effect of the immunomodulating agent, pentoxifylline, in the treatment of sepsis in prematurely delivered infants

Abstract

Pentoxifylline significantly affects the synthesis of TNF and IL-6 as well as reduces the mortality rate in premature infants with sepsis. The dosage and schedule of drug administration in this study attenuated the severity of the clinical course of sepsis in this group of patients.

Pentoxifylline Reduces the Incidence and Severity of Necrotizing Enterocolitis in a Neonatal Rat Model

“…Treatment at an early stage may therefore prevent progression of the illness, and reduce the length of the bowel that may be severely compromised with necrosis. Given that pentoxifylline has been used in chronic lung disease (29) and sepsis (25) in preterm neonates, and so far no adverse effects have been reported, a clinical trial may be justified based on our results. Caution, however, is warranted, as the concept of down-regulation of the inflammatory response is deceptively simple.…”

“…All investigators including the histopathologist (AC) and biostatistician (DD) were blinded to study group allocation. The dose of pentoxifylline used in the study was based on data from clinical trials of pentoxifylline in neonatal sepsis and chronic lung disease (25,29) and the intraperitoneal route was chosen for ease of administration.…”

“…Improved anastomotic healing following pentoxifylline treatment has been demonstrated in ischemia-reperfusion models (23). Pentoxifylline has also been shown to improve hemodynamic function and reduce plasma TNF-␣ levels and mortality in preterm neonates with blood culture-positive sepsis (24,25). Given the current understanding of inflammatory cytokines like TNF-␣ in the pathophysiology of the illness, pentoxifylline may be beneficial in the management of NEC.…”

Pentoxifylline Inhibits Tumor Necrosis Factor-Alpha Induced Synthesis of Complement Component C3 in Human Endothelial Cells

“…PTX has also been shown to improve cardiovascular function in adults with septic shock 12) and improve survival in premature infants with sepsis. 13) While PTX is known to decrease TNF secretion from neutrophils we have demonstrated for the first time that PTX antagonizes the effect of TNF on C3 synthesis in endothelial cells which may explain in part it's protection against vascular damage during sepsis.…”

International Neonatal Immunotherapy Study

“…[19][20][21] Two randomised controlled trials (RCT s) of pentoxifylline recruited 140 preterm infants with clinical sepsis. 21,22 Among the 107 with positive blood cultures, pentoxifylline was associated with an 86% reduction in risk of mortality (RR 0.14, 95% CI 0.03 to 0.76). Outcomes for the 33 infants not included in the analyses are not available.…”