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

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Abstract
Objective: To evaluate the efficacy of a single large oral dose of vitamin A in treating acute shigellosis in children in Bangladesh. Design: Randomised double blind controlled clinical trial. Setting: Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh. Subjects: 83 children aged 1–7 years with bacteriologically proved shigellosis but no clinical signs of vitamin A deficiency; 42 were randomised to treatment with vitamin A and 41 formed a control group. Intervention: Children were given a single oral dose of 200 000 IU of vitamin A plus 25 IU vitamin E or a control preparation of 25 IU vitamin E. Main outcome measures: Clinical cure on study day 5 and bacteriological cure. Results: Baseline characteristics of the subjects in the two treatment groups were similar. Significantly more children in the vitamin A group than in the control group achieved clinical cure (19/42 (45%) v 8/14 (20%); χ2=5.14, 1 df, P=0.02; risk ratio=0.68 (95% confidence interval: 0.50 to 0.93)). When cure was determined bacteriologically, the groups had similar rates (16/42 (38%) v 16/41 (39%); χ2=0.02, 1 df, P=0.89; risk ratio=0.98 (0.70 to 1.39)). Conclusions: Vitamin A reduces the severity of acute shigellosis in children living in areas where vitamin A deficiency is a major public health problem. 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