Increasing doses of pentoxifylline as a continuous infusion in canine septic shock.
We investigated effects of pentoxifylline during septic shock. Two-year-old (10-12 kg), purpose-bred beagles were infected i.p. with Escherichia coli 0111:B4 (1.2-1.5 x 10(9) colony-forming units per kilogram b.wt.) in a fibrin clot and then immediately treated with one of five doses of pentoxifylline (0.5-20 mg. kg-1. h-1 i.v.) as a 36-h continuous infusion or placebo. All animals received antibiotics and fluid resuscitation. Pentoxifylline levels increased in a dose-dependent manner during (p =.001) and were undetectable 12 h after stopping the infusion. During infusion of pentoxifylline at all doses, there were increases (p =.003), and once the infusion was stopped, there were decreases (p =.049) in endotoxin levels compared with controls. After clot implantation, at all pentoxifylline doses there was a significant increase in tumor necrosis factor levels, compared with controls (p =.025). The relative risk of death was significantly increased with pentoxifylline therapy in a dose-dependent fashion (20 >/= 10 >/= 5.0 >/= 1.0 >/= 0.5 mg. kg-1, p =.008). One hypothesis consistent with these data is that high pentoxifylline levels slowed endotoxin clearance, resulting in high levels of endotoxemia and increased proinflammatory mediator release and death. Pentoxifylline, used as a long-term continuous infusion as is commonly done clinically, can be harmful during Gram-negative septic shock.
Quezado
Z M
ZM
Department of Critical Care Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Hoffman
W D
WD
Banks
S M
SM
Danner
R L
RL
Eichacker
P Q
PQ
Susla
G M
GM
Natanson
C
C
D000704:Analysis of Variance; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001831:Body Temperature / Q000187:drug effects; D004195:Disease Models, Animal; D004285:Dogs; D004731:Endotoxins / Q000378:metabolism; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010431:Pentoxifylline / Q000008:administration & dosage*; D010538:Peritonitis / Q000188:drug therapy; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D012772:Shock, Septic / Q000188:drug therapy / Q000378:metabolism*; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D000900:Anti-Bacterial Agents; D004731:Endotoxins; D010726:Phosphodiesterase Inhibitors; D014409:Tumor Necrosis Factor-alpha; D010431:Pentoxifylline