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Recurrence of child pneumonia delayed by 100000 IU of vitamin D – RCT Oct 2010

Effects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomised controlled trial.

Trop Med Int Health. 2010 Oct;15(10):1148-55. doi: 10.1111/j.1365-3156.2010.02578.x. Epub 2010 Aug 17.
Manaseki-Holland S, Qader G, Isaq Masher M, Bruce J, Zulf Mughal M, Chandramohan D, Walraven G.
Kabul Medical University, Kabul, Afghanistan. Aga Khan Health Services, Kabul, Afghanistan

To determine whether (i) supplementation of oral 100,000 iu of vitamin D(3) (cholecalciferol) along with antibiotics will reduce the duration of illness in children with pneumonia; (ii) supplementation will reduce the risk of repeat episodes.

METHODS: Double-blind individually randomised placebo-controlled trial in an inner-city hospital in Kabul, of 453 children aged 1-36 months, diagnosed with non-severe or severe pneumonia at the outpatient clinic. Children with rickets, other concurrent severe diseases, very severe pneumonia or wheeze, were excluded. Children were given vitamin D(3) or placebo drops additional to routine pneumonia treatment.

RESULTS: Two hundred and twenty-four children received vitamin D(3;) and 229 received placebo.
There was no significant difference in the mean number of days to recovery between the vitamin D(3) (4.74 days; SD 2.22) and placebo arms (4.98 days; SD 2.89; P = 0.17).
The risk of a repeat episode of pneumonia within 90 days of supplementation was lower in the intervention (92/204; 45%) than the placebo group [122/211;
(58%; relative risk 0.78; 95% CI 0.64, 0.94; P = 0.01].
Children in the vitamin D(3) group survived longer without experiencing a repeat episode (72 days vs. 59 days; HR 0.71; 95% CI 0.53-0.95; P = 0.02).

CONCLUSION: A single high-dose oral vitamin D(3) supplementation to young children along with antibiotic treatment for pneumonia could reduce the occurrence of repeat episodes of pneumonia.
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Observations by VitaminDWiki

Single dose of 100,000 IU after pneumonia was full engaged did not help.
No surprise since the time for pneumonia to be treated, of about 5 days, is similar to the response time for serum level of vitamin D.
Half life of single dose is about 50 days, so it is not surprising that pneumonia recurred after that time.
Multiple doses, say on a monthly basis, might have virtually eliminated pneumonia recurrence, since the vitamin D levels would remain high.
Note that many of the same authors later (below) tried doses every 3 months – which is too long a period between doses to keep the vitamin D levels high enough.
Note also – 100,000 IU per 90 days would be an average of just 1,000 IU daily.

Effect on the incidence of pneumonia of vitamin D supplementation by quarterly bolus dose to infants in Kabul: a randomised controlled superiority trial.

Lancet. 2012 Apr 14;379(9824):1419-27. Epub 2012 Apr 10.
Manaseki-Holland S, Maroof Z, Bruce J, Mughal MZ, Masher MI, Bhutta ZA, Walraven G, Chandramohan D.
School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. s.manasekiholland at bham.ac.uk

Vitamin D has a role in regulating immune function, and its deficiency is a suggested risk factor for childhood pneumonia. Our aim was to assess whether oral supplementation of vitamin D(3) (cholecalciferol) will reduce the incidence and severity of pneumonia in a high-risk infant population.

We did a randomised placebo-controlled trial to compare oral 100,000 IU (2·5 mg) vitamin D(3) with placebo given to children aged 1-11 months in Kabul, Afghanistan. Randomisation was by use of a computer-generated list. Vitamin D or placebo was given by fieldworkers once every 3 months for 18 months. Children presenting at the study hospital with signs of pneumonia had their diagnosis confirmed radiographically. Our primary outcome was the first or only episode of radiologically confirmed pneumonia. Our analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00548379.

1524 children were assigned to receive vitamin D(3) and 1522 placebo. There was no significant difference between the incidence of first or only pneumonia between the vitamin D (0·145 per child per year, 95% CI 0·129-0·164) and the placebo group (0.137, 0·121-0·155); the incidence rate ratio was 1·06 (95% CI 0·89-1·27). From 652 children during five separate periods of testing serum calcifediol, only one child in each of two testing periods had results greater than 375 nmol/L in the intervention group- -a toxic level.

Vitamin D(3) supplementation to infants are not an effective intervention to reduce the incidence of pneumonia in infants in this setting.

Wellcome Trust and British Council.

Full text is on-line

See also VitaminDWiki