Single dose vitamin A treatment in acute shigellosis in Bangladeshi children: randomised double blind controlled trial

BMJ 1998;316:422-426 (7 February)

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Single dose vitamin A treatment in acute shigellosis in Bangladeshi children: randomised double blind controlled trial

Shahadat Hossain, senior medical officer,^a Rabi Biswas, research assistant,^a Iqbal Kabir, scientist,^a Shafique Sarker, associate scientist,^a Michael Dibley, senior lecturer,^b George Fuchs, director,^a Dilip Mahalanabis, former director ^a

^a Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh, ^b Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW 2300, Australia

Correspondence to: Dr Hossain shossain@icddrb.org

Objective: To evaluate the efficacy of a single large oral doseof vitamin A in treating acute shigellosis in children in Bangladesh.
Design: Randomised double blind controlled clinical trial.
Setting: Dhaka Hospital, International Centre for DiarrhoealDisease Research, Bangladesh.
Subjects: 83 children aged 1-7 years with bacteriologicallyproved shigellosis but no clinical signs of vitamin A deficiency;42 were randomised to treatment with vitamin A and 41 formeda control group.
Intervention: Children were given a single oral dose of 200000 IU of vitamin A plus 25 IU vitamin E or a control preparationof 25 IU vitamin E.
Main outcome measures: Clinical cure on study day 5 and bacteriologicalcure.
Results: Baseline characteristics of the subjects in the twotreatment groups were similar. Significantly more children inthe vitamin A group than in the control group achieved clinicalcure (19/42 (45%) v 8/14 (20%); {chi} ²=5.14, 1 df, P=0.02; risk ratio=0.68(95% confidence interval: 0.50 to 0.93)). When cure was determinedbacteriologically, the groups had similar rates (16/42 (38%)v 16/41 (39%); {chi} ²=0.02, 1 df, P=0.89; risk ratio=0.98 (0.70 to1.39)).
Conclusions: Vitamin A reduces the severity of acute shigellosisin children living in areas where vitamin A deficiency is amajor public health problem.

Key messages

A single oral dose of 200 000 IU vitamin A acts as an adjunct in the treatment of acute shigellosis among the children in geographical areas where vitamin A deficiency is a major public health problem
Vitamin A supplementation hastens clinical cure in acute shigellosis
Vitamin A supplementation during acute shigellosis has no effect on bacteriological clearance
Vitamin A may reduce the severity of acute shigellosis by promoting repair of the colonic mucosa and stimulating the immune system

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Relevant Article

Vitamin A for treating shigellosis: Mohammed Abdus Salam, Wasif Ali Khan, Ujjwal Dhar, Anne Ronan, Nigel C Rollins, Michael L Bennish, Shahadat Hossain, Rabi Biswas, Iqbal Kabir, Shafique Sarker, George Fuchs, Dilip Mahalanabis, and Michael Dibley
BMJ 1999 318: 939. [Extract] [Full Text]

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