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Vitamin D supplementation for treatment and prevention of pneumonia in under-five children: A randomized double-blind placebo controlled trial

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Abstract

Objective

To evaluate the efficacy of single oral mega-dose of Vitamin D3 for treatment and prevention of pneumonia in underfive children.

Design

Randomized, double blind, placebo-controlled trial.

Setting

Tertiary-care hospital.

Participants

324 children (of 980 assessed) between 6 mo-5 y age (median (IQR): 12 (7,19.8) mo) with WHO-defined severe pneumonia. Of these, 126 (39%) were vitamin D deficient (serum 25(OH)D <12 ng/mL).

Intervention

100,000 IU of oral cholecalciferol (n= 162) or placebo (n= 162) in single dose, administered at enrolment.

Outcome variables

Primary: Time to resolution of severe pneumonia and proportion of children having recurrence of pneumonia in next 6 months; Secondary: Change in serum levels of 25(OH)D; immunoglobulins IgA, IgG, IgM, and cathelicidin 2 weeks following supplementation; and time taken for overall resolution of illness.

Results

Median (95% CI) time for resolution of severe pneumonia was 30 (29, 31) h in the vitamin D group as compared to 31 (29,33) h in the placebo group [adjusted hazard ratio (95% CI): 1·39 (1·11, 1·76); P=0·005]. The risk of recurrence of pneumonia in next 6 months was comparable in the two groups [placebo: 36/158 (22·8%); vitamin D: 39/156 (25%); RR (95% CI): 1·13 (0·67,1·90); P=0·69]. Proportion of vitamin D deficient children declined from 38% to 4% in the supplementation group, and from 41% to 33% in the placebo group, two weeks after supplementation. There was no significant effect of vitamin D supplementation on serum levels of cathelicidin, IgA and IgG. The time taken for complete recovery from pneumonia, duration of hospitalization, and fever clearance time were comparable for the two groups. No adverse event was noted related to the intervention.

Conclusion

There is no robust evidence of a definite biological benefit, either for therapy or prevention, to suggest a routine megadose supplement of vitamin D3 for under-five children with severe pneumonia.

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Authors and Affiliations

  1. Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110 095, India

    Piyush Gupta, Pooja Dewan, Dheeraj Shah, Nisha Sharma & Nidhi Bedi

  2. Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

    Iqbal R. Kaur

  3. Department of Biostatistics and Medical Informatics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

    Ajay Kumar Bansal

  4. Division of Endocrinology, Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

    S.V. Madhu

Authors
  1. Piyush Gupta
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  2. Pooja Dewan
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  3. Dheeraj Shah
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  4. Nisha Sharma
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  5. Nidhi Bedi
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  6. Iqbal R. Kaur
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  7. Ajay Kumar Bansal
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  8. S.V. Madhu
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Correspondence to Piyush Gupta.

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Gupta, P., Dewan, P., Shah, D. et al. Vitamin D supplementation for treatment and prevention of pneumonia in under-five children: A randomized double-blind placebo controlled trial . Indian Pediatr 53, 967–976 (2016). https://doi.org/10.1007/s13312-016-0970-5

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  • DOI: https://doi.org/10.1007/s13312-016-0970-5

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