Vitamin C supplementation for prevention and treatment of pneumonia

Padhani, Zahra Ali; Moazzam, Zorays; Ashraf, Alina; Bilal, Hasana; Salam, Rehana A; Bhutta, Zulfiqar Ahmed

doi:10.1002/14651858.cd013134.pub2

Cited by 35 publications

(34 citation statements)

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“…Surprisingly few vitamin C intervention studies have been carried out in patients with pneumonia [ 31 , 32 ]. Administration of vitamin C at a dose of 200 mg/d to 28 elderly patients with pneumonia and bronchitis restored saturating vitamin C status within two weeks and also improved leukocyte vitamin C concentrations [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Patients with Community Acquired Pneumonia Exhibit Depleted Vitamin C Status and Elevated Oxidative Stress

et al. 2020

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Pneumonia is a severe lower respiratory tract infection that is a common complication and a major cause of mortality of the vitamin C-deficiency disease scurvy. This suggests an important link between vitamin C status and lower respiratory tract infections. Due to the paucity of information on the vitamin C status of patients with pneumonia, we assessed the vitamin C status of 50 patients with community-acquired pneumonia and compared these with 50 healthy community controls. The pneumonia cohort comprised 44 patients recruited through the Acute Medical Assessment Unit (AMAU) and 6 patients recruited through the Intensive Care Unit (ICU); mean age 68 ± 17 years, 54% male. Clinical, microbiological and hematological parameters were recorded. Blood samples were tested for vitamin C status using HPLC with electrochemical detection and protein carbonyl concentrations, an established marker of oxidative stress, using ELISA. Patients with pneumonia had depleted vitamin C status compared with healthy controls (23 ± 14 µmol/L vs. 56 ± 24 µmol/L, p < 0.001). The more severe patients in the ICU had significantly lower vitamin C status than those recruited through AMAU (11 ± 3 µmol/L vs. 24 ± 14 µmol/L, p = 0.02). The pneumonia cohort comprised 62% with hypovitaminosis C and 22% with deficiency, compared with only 8% hypovitaminosis C and no cases of deficiency in the healthy controls. The pneumonia cohort also exhibited significantly elevated protein carbonyl concentrations compared with the healthy controls (p < 0.001), indicating enhanced oxidative stress in the patients. We were able to collect subsequent samples from 28% of the cohort (mean 2.7 ± 1.7 days; range 1–7 days). These showed no significant differences in vitamin C status or protein carbonyl concentrations compared with baseline values (p = 0.6). Overall, the depleted vitamin C status and elevated oxidative stress observed in the patients with pneumonia indicates an enhanced requirement for the vitamin during their illness. Therefore, these patients would likely benefit from additional vitamin C supplementation to restore their blood and tissue levels to optimal. This may decrease excessive oxidative stress and aid in their recovery.

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Section: Discussionmentioning

confidence: 99%

“…Thus, administration of vitamin C to depleted pneumonia patients may improve their clinical outcomes. More well-controlled trials are required to test this [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Patients with Community Acquired Pneumonia Exhibit Depleted Vitamin C Status and Elevated Oxidative Stress

et al. 2020

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“…The clinical classification of pneumonia include: community‐acquired pneumonia, aspiration pneumonia, healthcare‐associated pneumonia, hospital acquired pneumonia, and ventilator‐associated pneumonia (Sharma et al., 2007). Pneumonia is caused by a variety of microorganisms, including fungi, bacteria, and viruses (Padhani et al., 2020). Attention has now turned to the importance of viruses as pathogens of pneumonia (Ruuskanen et al., 2011).…”

Section: Introductionmentioning

confidence: 99%

Integrated network pharmacology and molecular docking strategy to explore the mechanism of medicinal and edible Astragali Radix‐Atractylodis Macrocephalae Rhizoma acting on pneumonia via immunomodulation

2020

J. Food Biochem.

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Pneumonia refers to a death-causing infection. Astragali Radix (AR) and Atractylodis Macrocephalae Rhizoma (AMR) are widely used as traditional tonic and promising edible immunomodulatory herbal medicine, but the systemic mechanism is not well understood. Therefore, a strategy based on network pharmacology and molecular docking was designed to explore the systemic mechanism of AR-AMR acting on pneumonia. After a series of bioinformatics assays, seven kernel targets were obtained, including TNF, IL6, IFNG, IL1B, IL10, IL4, and TLR9. And seven key compounds were identified as the synergy components of AR-AMR acting on pneumonia, the four key compounds belonging to AR were (3R)-3-(2-hydroxy-3,4-dimethoxyphenyl)-7chromanol, formononetin, quercetin, and kaempferol, the three key compounds belonging to AMR were atractylone, 14-acetyl-12-senecioyl-2E, 8E, 10E-atractylentriol, and α-Amyrin. The crucial pathways were mainly related to three modules, including immune diseases, infectious disease, and organismal systems. Collectively, these observations strongly suggest that the molecular mechanisms of AR-AMR regulating pneumonia were closely related to the correlation between inflammation and immune response. Practical applications Astragali radix and Atractylodis macrocephalae rhizoma can be used as "medicinefood homology" for dietary supplement. AR and AMR are widely used as a traditional tonic and promising edible immunomodulatory herbal medicine. The AR-AMR herb pairs are used for compatibility many times in the recommended prescriptions in COVID-19 develop pneumonia in China. However, the ingredients and mechanisms of AR-AMR acting on Pneumonia via immunomodulation are unclear. In this paper, bioinformatics and network biology were used to systematically explore the mechanisms of the AR-AMR herb pairs in treatment of pneumonia, and further analyze the correlation mechanism between it and COVID-19 develop pneumonia. To sum up, our study reveals the interrelationships between components, targets, and corresponding biological processes of AR-AMR acting on pneumonia. Understanding

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“…Results of a recently published Cochrane systematic review showed skepticism about the effect of vitamin C supplementation for prevention and treatment of pneumonia. They also emphasized to conduct better-quality studies for assessment of the role of vitamin C supplementation in the prevention and treatment of pneumonia 7 . Considering the dosing and route of administration is very important regarding vitamin C therapy in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit

Mahmoodpoor

Shadvar

Sanaie

et al. 2020

Preprint

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Background: Critically ill patients are frequently suffering from vitamin C deficiency. Previous studies showed that high doses of vitamin C administration had conflicting results on clinical outcomes in patients with severe sepsis, burns and trauma. Because of high incidence and morbidity/mortality with severe pneumonia, we aimed to investigate the effect of administration of high dose vitamin C in critically ill patients with severe pneumonia.Methods: Eighty critically ill patients with pneumonia were enrolled in this randomized double blinded clinical trial. Patients with CURB-65 score >3, one major criteria, or ≥3 minor criteria were considered as severe pneumonia. Patients were randomly assigned to intervention or placebo groups receiving standard treatment plus 60 mg/kg/day vitamin C as continuous infusion or normal saline in the same volume correspondingly for 96 hours. Serum levels of vitamin C were noted at baseline and 48 hours after vitamin C administration. Duration of mechanical ventilation, ICU length of stay, PaO2/FiO2 and mortality rate were noted for all patients till the 28th day. Any complications related to vitamin C administration were recorded. (IRCT registration number: IRCT20190312043030N1, Registration date: 2019-08-26, seied hadi saghaleini).Results: Duration of mechanical ventilation and vasopressor use were significantly lower in intervention group (p: <0.001 and 0.003, respectively). Baseline levels of vitamin C in both groups did not have significant difference but its levels increased in intervention group and decreased in control group during the study period. Mortality rate insignificantly decreased in intervention group (p: 0.17). Three patients showed hypotension and tachycardia during the administration of vitamin C which was self-limited with decreasing the dose of vitamin C. Conclusion: Our results showed that the intravenous administration of a relatively high dose of vitamin C to critically ill patients with severe pneumonia was safe and could decrease the inflammation, mechanical ventilation duration and vasopressor use without any significant effect on mortality.

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Vitamin C supplementation for prevention and treatment of pneumonia

Cited by 35 publications

References 53 publications

Patients with Community Acquired Pneumonia Exhibit Depleted Vitamin C Status and Elevated Oxidative Stress

Patients with Community Acquired Pneumonia Exhibit Depleted Vitamin C Status and Elevated Oxidative Stress

Integrated network pharmacology and molecular docking strategy to explore the mechanism of medicinal and edible Astragali Radix‐Atractylodis Macrocephalae Rhizoma acting on pneumonia via immunomodulation

Effect of Vitamin C on mortality of critically ill patients with severe pneumonia in intensive care unit

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