Randomised, double blind, placebo controlled clinical trial of efficacy of vitamin A treatment in non-measles childhood pneumonia

Abstract Objective: To evaluate the impact on clinical recovery and severity of the addition of large doses of vitamin A to the standard treatment for childhood pneumonia. Design: A randomised, double blind, placebo controlled trial. Setting: Study children were recruited at a public hospital in Recife, north east Brazil, an area of marginal vitamin A deficiency. Subjects: 472 children aged 6 to 59 months with clinical diagnosis of pneumonia. Interventions: 200 000 IU (infants) or 400 000 IU (1-4 year olds) of vitamin A in oil or similar capsules of placebo divided into two daily oral doses, in addition to the standard treatment. Main outcome measures: Duration of the episode and incidence of adverse outcomes. Results: The groups were similar with respect to overall duration of pneumonia and incidence of adverse outcomes. Children who received vitamin A, however, were less likely to have fever by day 3 (P=0.008) and were 29% less likely to fail to respond to the first line antibiotic (P=0.054). Conclusion: There was little evidence for an effect of vitamin A treatment on the immediate outcome of the pneumonia episode. Key messages Pneumonia is a leading cause of childhood mortality in developing countries Vitamin A supplementation has no impact on mortality from pneumonia even though it reduces overall mortality Treatment of measles pneumonia with vitamin A reduces case fatality and severity of disease This study showed that vitamin A treatment has no impact on the recovery from non-measles pneumonia, despite some suggestion that severely affected patients may benefit The addition of vitamin A for treatment protocols for childhood pneumonia is not recommended for clinical cure, although it maybe a useful contact to improve vitamin A status