The role of supplementary vitamin D in treatment course of pulmonary tuberculosis
Egyptian Journal of Chest Diseases and Tuberculosis, doi:10.1016/j.ejcdt.2016.03.004
Essam Gouda Hassaneina, Enas El Said Mohammada, Ayman Ibrahim Baessa, , , Eman Tayae EL-Sayedb, Ahmad Madi Yossefc
Injection of vitamin D has several benefits
- No concern about patient forgetting to take vitamin D periodically
- No concern about vitamin D being blocked by poor gut
- Injection provides a loading dose, which restores vitamin D levels in days, rather than months
See also Vitamin D Life
- Tuberculosis 4.5X more likely if vitamin D less than 10 nanogram – meta-analysis May 2015
- Multidrug-resistant tuberculosis may be reduced with vitamin D – Sept 2012
- Tuberculosis risk decreased by 6 percent for each 1 ng increase in Vitamin D – Oct 2014
TB Prevention, not just treatment - Smoking reduces vitamin D
wonder if Smoking ==> reduce Vitamin D ==> increased risk of TB (and other health problems) - Search Vitamin D Life for INJECTION 768 items as of April 2016
- Review of Vitamin D (including free, frequency, injection, how much.) – Sept 2013
- Vitamin D supplementation protocols: loading, injection, etc – RCT June 2014
- Diabetes (Type II) reduced by single injection of 300,000 IU of vitamin D3 – RCT March 2014
Overview Loading of vitamin D contains the following
Loading dose:Vitamin D loading dose (stoss therapy) proven to improve health overview
If a person is or is suspected to be, very vitamin D deficient a loading dose is typically given
- Loading = restore = quick replacement by 1 or more doses
- Loading doses range in total size from 100,000 IU to 1,000,000 IU of Vitamin D3
- = 2.5 to 25 milligrams
- The size of the loading dose is a function of body weight - see below
- Unfortunately, some doctors persist in using Vitamin D2 instead of D3
- Loading may be done as quickly as a single day (Stoss), to as slowly as 3 months.
- It appears that spreading the loading dose over 4+ days is slightly better if speed is not essential
- Loading is typically oral, but can be Injection (I.M,) and Topical
- Loading dose is ~3X faster if done topically or swished inside of the mouth
- Skips the slow process of stomach and intestine, and might even skip liver and Kidney as well
- The loading dose persists in the body for 1 - 3 months
- The loading dose should be followed up with on-going maintenance dosing
- Unfortunately, many doctors fail to follow-up with the maintenance dosing.
- About 1 in 300 people have some form of a mild allergic reaction to vitamin D supplements, including loading doses
- it appears prudent to test with a small amount of vitamin D before giving a loading dose
- The causes of a mild allergic reaction appear to be: (in order of occurrence)
- 1) lack of magnesium - which can be easily added
- 2) allergy to capsule contents - oil, additives (powder does not appear to cause any reaction)
- 3) allergy to the tiny amount of D3 itself (allergy to wool) ( alternate: D3 made from plants )
- 4) allergy of the gut to Vitamin D - alternative = topical
Intervention AND TB in Vitamin D Life
- TB not treated by average daily 10,000 IU of vitamin D (previous RCTs disagree) – RCT Sept 2017
- Tuberculosis recovery speeded up by single 450,000 IU dose of vitamin D – RCT Jan 2017
- Tuberculosis treatment greatly helped by injection of 200,000 IU of vitamin D – RCT April 2016
- Tuberculosis -100 percent cure rate with 10,000 IU of vitamin D daily – RCT 2006
- Tuberculosis not treated by lots of vitamin D for 16 weeks – RCT Sept 2015
- Every TB patient benefited from 2 doses of 600,000 IU of vitamin D – RCT Jan 2013
- TB treatment helped with Vitamin D – RCT Sept 2012
- Probability of getting TB reduced 60 percent with just 800 IU of vitamin D – RCT Aug 2012
- Overview Tuberculosis and Vitamin D
- Evaluating the vitamin D evidence - Heaney Dec 2010
Download the PDF from Vitamin D Life
Background: Vitamin D insufficiency/deficiency is associated with impaired immune function and increased risk of active pulmonary tuberculosis (TB).
Objectives: To evaluate the role of vitamin D as supplementary treatment with the first line anti-tuberculous drugs (rifampicin, izoniazide, ethambutol and pyrazinamide) in treatment course of patients with active pulmonary tuberculosis.
Methods: We conducted a case-control study in El Maamora chest hospital, Alexandria governorate, Egypt, including 60 adult patients with active pulmonary TB of 30 patients each. Patients in group I (cases) received vitamin D (200,000 IU) intramuscular injection once besides anti-tuberculous drugs, while patients in group II (controls) were randomly selected from the hospital registry who received the first line anti-tuberculous treatment only. The primary outcome was evaluation of conversion time of sputum smear. The secondary outcome was clinical improvement as assessed by TB score.
Measurements and main results: Mean ± SD age of all patients was 41.55 ± 14.91 years. The study included 44 (73.3%) males and 16 (26.7%) females. Vitamin D deficiency/insufficiency was detected in 54 (90%) patients. Comparing the two groups, there was a rapid decline in sputum conversion time and severity classes of TB score in group I compared to group II (p < 0.001 and p = 0.02, respectively). No complications secondary to supplementary vitamin D were met all through the study.
Conclusion: Vitamin D accelerates the improvement observed in vitamin D supplemented TB therapy. Vitamin D is safe when added to anti-tuberculous drugs. Vitamin D deficiency/insufficiency is common among TB patients. Further studies are required to validate this observation and define a cut off of vitamin D level to prevent immunological alterations.
Smoking is bad for TB - Clipped from PDF
"patients who smoke had a fivefold (p < 0.0001) higher odds of having active tuberculosis compared with patients who do not smoke."
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