What is the recommended dose of Vitamin A (Vitamin A) for an adult patient with measles?

Vitamin A Dosing for Adults with Measles

Adults with measles should receive 200,000 IU of vitamin A orally on day 1, with a second dose of 200,000 IU on day 2 if complications develop (pneumonia, otitis, croup, diarrhea with dehydration, or neurological problems). 1

Standard Dosing Protocol

• All adults with clinical measles should receive 200,000 IU of vitamin A orally as the standard dose, provided they have not received vitamin A supplementation in the previous month 1
• The 200,000 IU dose applies to all patients ≥12 months of age, including adults 1, 2, 3, 4
• This is the only evidence-based intervention proven to reduce measles mortality and should never be omitted 2, 3

Repeat Dosing for Complicated Cases

• A second dose of 200,000 IU should be administered on day 2 for adults who develop complications including:
  • Pneumonia or acute lower respiratory infection 1, 2
  • Otitis media 1
  • Croup or laryngotracheobronchitis 1
  • Diarrhea with moderate or severe dehydration 1
  • Neurological problems or encephalitis 1

Evidence Supporting Two-Dose Regimen

• Two doses of 200,000 IU given on consecutive days reduce overall mortality by 64% (RR 0.36,95% CI 0.14-0.82) compared to placebo 5, 6
• The two-dose regimen reduces pneumonia-specific mortality by 67% (RR 0.33,95% CI 0.08-0.92) in hospitalized patients 5, 6
• A single dose of 200,000 IU was not associated with reduced mortality (RR 1.25,95% CI 0.48-3.1), making the two-dose approach critical for complicated cases 5, 6

Special Circumstances: Eye Symptoms

• If any eye symptoms of vitamin A deficiency are present (xerosis, Bitot's spots, keratomalacia, or corneal ulceration), administer an extended treatment schedule 1:
  • 200,000 IU oral vitamin A on day 1
  • 200,000 IU oral vitamin A on day 2
  • 200,000 IU oral vitamin A 1-4 weeks later

Clinical Context and Rationale

• Vitamin A supplementation reduces the incidence of croup by 47% (RR 0.53,95% CI 0.29-0.89) and decreases the duration of diarrhea by approximately 2 days 6, 7
• The intervention is highly cost-effective and should be part of routine case management for all hospitalized measles patients 8
• Adults with measles require hospitalization in 25% of cases, with encephalitis or death occurring in approximately 1 per 1,000 cases, making vitamin A supplementation particularly important 4

Common Pitfalls to Avoid

• Do not forget vitamin A supplementation—it is the only evidence-based treatment to reduce measles mortality and should be administered at the first clinical encounter 2, 3
• Do not withhold the second dose on day 2 if complications are present, as single-dose regimens have not demonstrated mortality benefit 5, 6
• Do not delay vitamin A administration while awaiting laboratory confirmation of measles, as treatment should begin immediately upon clinical diagnosis 2, 3