Must add vitamin D with DOTS treatment in pulmonary tuberculosis

DOTS or Directly Observed Treatment Short course is the internationally recommended strategy for TB control that has been recognized as a highly efficient and cost-effective strategy.

At present it is the preferred treatment modality for TB and it typically comprises of biphasic administration of anti-tubercular drugs, intensive phase and continuous phase, respectively. As a consequence of the rise in DOTS therapy, TB treatment with the earlier vitamin D rich modalities has dwindled. There is Impaired metabolism in patients with pulmonary tuberculosis which is likely to worsen the effects of vitamin D deficiency (VDD).

As per the existing research on the interaction between vitamin D and anti-tubercular drugs, rifampicin causes an accelerated loss of vitamin D because of increased clearance, thereby causing Vitamin D Deficiency..

The present is an Indian study which involved 44 newly diagnosed PTB patients of both the sexes in the age group of 18 to 60 years. The patients were recruited before starting DOTS, in this non-randomised controlled trial with their voluntary consent. Vitamin D status at baseline and the effect of DOTS on vitamin D were analysed.

Mean vitamin D levels of the study population were 20.74 ng/ml (normal >30 ng/ml) at baseline. However, six months of DOTS therapy reduced the vitamin D levels to 17.49 ng/ml (P=0.041). 70% of the participants exhibited a decrease in vitamin D levels from baseline, while a rise was seen in the remaining 30%. A possible role of younger age was implied in the improved vitamin D status.

It was concluded that Vitamin D Deficiency was evident in Pulmonary TB patients, which worsened in a majority of the study population following DOTS treatment. The authors therefore recommend vitamin D supplementation in PTB patients undergoing anti-tubercular treatment.