What are the guidelines for using Vitamin A 200,000 International Units (IU) for treatment?

Vitamin A 200,000 IU: Clinical Guidelines for Use

Vitamin A 200,000 IU is indicated for three specific clinical scenarios: treatment of measles in children ≥12 months, treatment of clinical vitamin A deficiency with xerophthalmia, and prophylactic supplementation in high-risk populations every 3-6 months. 1, 2

Treatment of Measles in Children

For all children with clinical measles who have not received vitamin A in the previous month, administer 200,000 IU orally (100,000 IU for children <12 months). 1

• Children with complicated measles (pneumonia, otitis, croup, diarrhea with moderate/severe dehydration, or neurological problems) require a second dose of 200,000 IU on day 2 1
• Two doses of 200,000 IU reduce overall mortality by 64% (RR=0.36) and pneumonia-specific mortality by 67% (RR=0.33) 3
• The mortality benefit is greatest in children under 2 years of age, with an 82% reduction in risk (RR=0.18) 3
• After treatment, repeat vitamin A supplementation every 3 months as part of routine prophylaxis 1

Treatment of Clinical Vitamin A Deficiency (Xerophthalmia)

For children presenting with eye symptoms of vitamin A deficiency (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), use the following three-dose regimen: 1, 2

• Day 1: 200,000 IU oral vitamin A 1, 2
• Day 2: 200,000 IU oral vitamin A 1, 2
• 1-4 weeks later: 200,000 IU oral vitamin A 1, 2
• Children <12 months receive half doses (100,000 IU at each time point) 1, 2

Prophylactic Supplementation in High-Risk Populations

Children aged 12 months to 5 years in populations where vitamin A deficiency is a public health problem should receive 200,000 IU every 3-6 months. 2, 4

• Infants <12 months receive 100,000 IU every 3-6 months (total 400,000 IU in first year) 2, 4
• Postpartum mothers should receive 200,000 IU within 2 months of delivery to provide adequate vitamin A in breast milk 2, 4
• This regimen is one of the most cost-effective interventions in international public health 4

Adult Dosing: When 200,000 IU is NOT Appropriate

For adults, 200,000 IU is NOT a standard treatment dose and should be avoided. 1, 5, 2

• Adult vitamin A deficiency without corneal involvement: 10,000-25,000 IU daily for 1-2 weeks 1, 5, 2
• Adult prophylaxis after bariatric surgery: 10,000 IU daily 5, 6
• Recheck vitamin A levels at 3 months after treatment 1, 2

Critical Safety Considerations

Acute toxicity can occur with doses >300,000 IU in adults or >60,000 IU in children within hours to days. 1

• Symptoms include increased intracranial pressure, nausea, headaches, and bone/joint pain 1
• Chronic toxicity results from >25,000 IU daily for >6 years or >100,000 IU daily for >6 months 1
• The upper limit for women of childbearing age is 10,000 IU daily due to teratogenic risk 1, 5
• Pregnant women should never receive 200,000 IU doses 5, 6

Common Pitfalls to Avoid

• Do not give 200,000 IU to adults for routine deficiency treatment—this dose is reserved for children and specific emergency situations 1, 5, 2
• Do not administer to pregnant women—teratogenic risk exists at doses ≥25,000 IU daily 7
• Do not give single 200,000 IU doses for measles—two doses are required for mortality benefit 3
• Do not forget the second dose on day 2 for complicated measles—this is critical for reducing pneumonia mortality 1
• Do not use water-soluble formulations when oil-based are available—water-based preparations show greater efficacy in reducing mortality (81% vs 48% reduction) 3

Monitoring and Follow-Up

• Document all 200,000 IU doses on the child's growth record chart 2
• For treatment of deficiency, recheck vitamin A levels 3 months after completing the regimen 1, 2
• Monitor for clinical improvement in night vision and other deficiency symptoms 2
• If deficiency does not respond to oral treatment, refer for specialist assessment and consideration of intramuscular injections 1, 2