Abstract

We investigated effects of pentoxifylline during septic shock. Two-year-old (10–12 kg), purpose-bred beagles were infected i.p. withEscherichia coli 0111:B4 (1.2–1.5 × 10⁹ 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.