RESPONSE OF BITOT SPOTS TO A SINGLE ORAL 100,000-IU OR 200,000-IU DOSE OF VITAMIN-A

PURPOSE: A randomized, controlled clinical trial was conducted in Indo nesia to study the response of Bitot's spots to a 100,000-IU dose of v itamin A, which is known to be associated with fewer acute side effect s than the currently recommended 200,000-IU dose. METHODS: A total of 114 children (ages 13 to 59 months) with Bitot's spots were given an o cular examination; serum retinol concentration was measured, and the r elative dose response test carried out. After administering one 100,00 0- or 200,000-IU oral dose of vitamin A, ocular examinations were repe ated weekly for seven weeks and then biweekly for 20 more weeks, or un til lesions were healed on two consecutive examinations. RESULTS: Eith er dose of vitamin A was similarly effective in healing Bitot's spots. The most important factor in predicting responsiveness to treatment w as baseline serum retinol concentration: children with lower pretreatm ent concentrations were more likely to have responsive lesions. No chi ld had a relapse within the first three months after treatment. Howeve r, by six months, children who had received the higher dose were 82% l ess likely to have a relapse compared with children who had received t he lower dose. CONCLUSIONS: Although either a 100,000- or 200,000-IU d ose of vitamin A is similarly effective in healing Bitot's spots, a 20 0,000-IU dose provides longer protection. This benefit justifies the h igher rates of transient mild side effects associated with the 200,000 -IU dose. The current 200,000-IU dose of vitamin A recommended by the World Health Organization for prophylactic dosing should not be reduce d.