Pentoxifylline in perforated peritonitis: results of a randomised, placebo controlled trial.
OBJECTIVE
To evaluate the role of pentoxifylline as an adjuvant to operation and routine antibiotic treatment for perforated peritonitis.


METHODS
Randomised controlled clinical trial.


METHODS
University hospital, India.


METHODS
36 patients with clinically diagnosed and radiologically confirmed perforated peritonitis. 22 (61%) had typhoid enteric perforations, 11 (31%) had duodenal ulcer perforations while 3 (8%) had perforated gastric ulcers.


METHODS
Laparotomy with closure of perforation and lavage together with routine antibiotic treatment (ciprofloxacin and metronidazole), and random allocation to pentoxifylline 200 mg/day for 3 days in 500 ml of saline over 3-4 hours or saline alone (n = 18 in each group).


METHODS
Hospital stay, APACHE II scores, and the condition of the wound during the postoperative period.


RESULTS
The baseline characteristics of the two groups were essentially similar. However, their preoperative APACHE II scores differed significantly (mean (SD) 12 (3) in the pentoxifylline group compared with 10 (2) in the saline group; p <0.01). The outcome was better in the pentoxifylline group in terms of significantly reduced hospital stay (median 8, range 6-17, compared with 11, 7-27, p=0.02) improved postoperative APACHE II scores (mean (SD) 8 (2) compared with 9 (2), p=0.02), and reduced incidence of wound infection (6/18 compared with 12/18, p=0.02).


CONCLUSIONS
The addition of pentoxifylline to our standard management protocol for patients with perforated peritonitis helped to improve their outcome significantly compared with a placebo-treated group.
Shukla
V K
VK
Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Ojha
A K
AK
Pandey
M
M
Pandey
B L
BL
D018806:APACHE; D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007416:Intestinal Perforation / Q000150:complications* / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010431:Pentoxifylline / Q000008:administration & dosage* / Q000009:adverse effects; D010538:Peritonitis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D011182:Postoperative Care; D011300:Preoperative Care; D014945:Wound Healing
D010431:Pentoxifylline