Pentoxifylline as Adjunctive Therapy in Children with Acute Bacterial Meningitis

Abstract

Introduction. Pentoxifylline, an inhibitor of tumor necrosis factor, has been shown in animal models of acute bacterial meningitis that reduce the host inflammatory response. Objective. To evaluate the effect of pentoxifylline administrated as adjunctive therapy in the treatment of acute bacterial meningitis in children. Material and methods. Prospective and open study that included children, between 3 months to 15 years old hospitalized in the Institute of Tropical Medicine, of Asunción, Paraguay, with the diagnosis of acute bacterial meningitis. Patients were randomly assigned, to receive in addition to antibiotic therapy (cefotaxime or ceftriaxone) pentoxifylline, dexamethasone, or neither. The presenting status was recorded and the course of disease monitored with preset criteria. The primary endpoints comprised death and severe neurological sequelae. Results. Eighty seven children received as adjunctive drug pentoxifylline (n=35), dexamethasone (n=30) and neither (n=22). At admission, the demographic, clinical and laboratory characteristics of the patients were comparable. There were no significant differences among the three groups regarding to the duration of fever and meningeal symptoms after admission. The mortality were comparable (11% in pentoxifylline, 13% in dexamethasone and 9% in control group) (p>0.6). Among the survivor patients, unfavorable outcome (severe sequelae) was observed in 13%, 20% and 15% for pentoxifylline-, dexamethasone- and control-group, respectively (p>0.5). Conclution. The data of the present study do not support the routine use of pentoxifylline as adjunctive therapy for bacterial meningitis in children.