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Vitamin A for treating shigellosis

BMJ 1999; 318 doi: (Published 03 April 1999) Cite this as: BMJ 1999;318:939

Study did not prove benefit

  1. Mohammed Abdus Salam, Chief physician,
  2. Wasif Ali Khan, Physician,
  3. Ujjwal Dhar, Physician,
  4. Anne Ronan, Paediatrician,
  5. Nigel C Rollins, Consultant,
  6. Michael L Bennish, Associate professor
  1. International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh
  2. Child and Family Health Services, Wallsend Campus, Newcastle, New South Wales, Australia
  3. Department of Paediatrics and Child Health, University Natal, Private Bag 7, Congella 4013, South Africa
  4. Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Tufts University School of Medicine, Boston, MA, United States
  5. International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128, Dhaka 1000, Bangladesh
  6. Society for Applied Studies 108 Maniktola Main Road, Flat 3/21, Calcutta 700 054, India
  7. Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, NSW 2308, Australia

    EDITOR—Hossain et al conclude that vitamin A along with standard antibiotic reduces the severity of acute shigellosis and that vitamin A supplementation should be added to the standard treatment for acute shigellosis.1 We disagree with those conclusions.

    The benefit of vitamin A as adjuvant treatment for shigellosis can be judged only in a study in which patients receive adequate antimicrobial treatment.2 In Hossain et al's study 64% of patients were infected with strains of shigella resistant to nalidixic acid, which was used to treat study patients. It is unclear how many patients were given an alternative effective antibiotic or when treatment was changed.

    The inadequacy of antimicrobial treatment in this study is reflected in clinical cure rates of less than 50% in patients who did and did not receive vitamin A supplements. That is not acceptable as adequate antimicrobial treatment routinely achieves a cure rate of 65% or more. 3 4 Indeed, Hossain and colleagues calculated their sample size based on a 98% cure rate in the vitamin A group. …

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