[The role of pentoxifylline in nitrogen conversion in patients suffering from diabetic phlegmona of the foot].

INTRODUCTION: It is known that pentoxifylline is the only medicament to date which has been clinically proven to lead to nitrogen conversion in uremic patients. Positive results of application of pentoxifylline in prevention of systemic inflammatory response syndrome have also been published, as well as in prevention and treatment of the acute respiratory distress syndrome.

OBJECTIVE: The goal of our study was to investigate the effect of four-day treatment with pentoxifylline in a dose of 300 mg dissolved in 500 ml of normal saline, administered as 20-hour intravenous infusion per day, on the conversion of nitrogen in 11 patients suffering from diabetic phlegmona of the foot, and with pathological values of urea and creatinine.

METHOD: All patients had 3 repeated negative blood cultures, and at least one positive out of three wound swabs. Seven patients were insulin independent, and 4 insulin dependent. Before treatment, all patients had pathological findings of white blood cells, in the form of granulocytosis, with appearance of young cells. Patients were prescribed adequate antibiotics according to drug susceptibility test, and glycemia was monitored every 6 hours, with correction of diabetes therapy. Patient's dressings were changed once a day, while urea and creatinine were checked immediately before the onset of pentoxifylline therapy, as well as after four days of therapy. Statistical analysis was done using the McNemar test for linked sample.

RESULTS: The results showed that pathological values of white blood cells persisted in all patients, and after four days of therapy, blood urea restored to normal in 9 patients (Z = -3; p = 0.003), and blood creatinine in 10 patients (Z = -3, 162; p = 0.002). There was no need to make corrections of diabetes therapy.

CONCLUSION: It can be concluded that pentoxifylline can prevent further degradation of nitrogen in patients suffering from phlegmona of the foot, decreasing the catabolic effect of infection, most probably by inhibiting the effect of TNF-alpha, interleukin-1 and interleukin-6, without any significant effect on leukocytosis during four days of treatment.