title: Vitamin D Supplementation for Treatment and Prevention of Pneumonia in Under-five Children: A Randomized Double-blind Placebo Controlled Trial.
abstract: OBJECTIVE
  To evaluate the efficacy of single oral mega-dose of Vitamin D3 for treatment and prevention of pneumonia in under-five children.
  
  
  METHODS
  Randomized, double blind, placebo-controlled trial.
  
  
  METHODS
  Tertiary-care hospital.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics; *Department of Microbiology; $Department of Biostatistics and Medical Informatics; and #Division of Endocrinology, Department of Medicine; University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. Correspondence to: Dr Piyush Gupta, Professor of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi 110 095, India. prof.piyush.gupta@gmail.com.
authors.forename: Piyush
authors.initials: P
authors.lastname: Gupta
authors.forename: Pooja
authors.initials: P
authors.lastname: Dewan
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Shah
authors.forename: Nisha
authors.initials: N
authors.lastname: Sharma
authors.forename: Nidhi
authors.initials: N
authors.lastname: Bedi
authors.forename: Iqbal R
authors.initials: IR
authors.lastname: Kaur
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Bansal
authors.forename: S V
authors.initials: SV
authors.lastname: Madhu
mesh_terms: D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D012008:Recurrence; D014807:Vitamin D / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014807:Vitamin D