Evidence-Based Evaluation of Vitamin C and D in the Treatment and Prevention of Acute Viral Respiratory Infectious Disease
SONG Zai-wei1,2, WANG Guan-ru1,2,3, LIU Shuang1,2,3, HU Yang1,2,3, ZHAO Rong-sheng1,2*
1. Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China; 2. Institute for Drug Evaluation, Peking University Health Science Center, Beijing 100191, China; 3. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
Abstract：OBJECTIVE To evaluate the evidence supporting vitamin C and D medication in the treatment and prevention of acute viral respiratory infectious disease, and to provide evidence for clinical rational medication and potential treatment option for COVID-19 especially. METHODS PubMed database was retrieved from inception to February 13, 2020, and the references in the reviews and those not included in the database were manually retrieved. RESULTS Eight literatures were included finally. In terms of COVID-19, MERS, and SARS, none literature about vitamin C and D medication was available. In terms of influenza, one prospective controlled trial proved vitamin C′s efficacy. For vitamin D in influenza, one systematic review and one randomized controlled trial proved its efficacy, while three randomized controlled trials showed no efficacy. Additionally, one case-control study showed no statistical association between vitamin D level and the risk of influenza, and one randomized controlled trial showed no significant difference between high-dose and standard-dose vitamin D supplementation. CONCLUSION Currently, no evidence supports the effectiveness of vitamin C and D medication in the prevention and treatment of COVID-19, MERS and SARS. However, limited evidence supports potential benefit of vitamin C and D medication in influenza. Physicians and pharmacists should take relevant clinical practice guidelines and supporting evidence into consideration when using vitamin C or D (especially high-dose medication), and pay attention to monitoring drug adverse reactions and drug interactions.
宋再伟, 王冠儒, 刘爽, 胡杨, 赵荣生. 维生素C与维生素D治疗与预防病毒性急性呼吸道感染的循证评价[J]. 中国药学杂志, 2020, 55(13): 1117-1121.
SONG Zai-wei, WANG Guan-ru, LIU Shuang, HU Yang, ZHAO Rong-sheng. Evidence-Based Evaluation of Vitamin C and D in the Treatment and Prevention of Acute Viral Respiratory Infectious Disease. Chinese Pharmaceutical Journal, 2020, 55(13): 1117-1121.
PAULING L. The significance of the evidence about ascorbic acid and the common cold[J]. Proc Natl Acad Sci USA, 1971, 68(11):2678-2681.
[2]
PRAPOJ P. Vitamin C for preventing and treating the common cold[J]. PLoS Med, 2015, 2(6):CD000980.
[3]
MARTINEAU A R, JOLLIFFE D A, HOOPER R L, et al. Vitamin D supplementation to prevent acute respiratory tract infections:systematic review and meta-analysis of individual participant data[J]. BMJ, 2017, 356:i6583.
[4]
MARIK P E. Vitamin C for the treatment of sepsis: the scientific rationale[J]. Pharmacol Ther, 2018, 189:63-70.
[5]
WATKINS R R, LEMONOVICH T L, SALATA R A. An update on the association of vitamin D deficiency with common infectious diseases[J]. Can J Physiol Pharmacol, 2015, 93(5):363-368.
[6]
ZHAO R S, YANG Y H, YANG L, et al. CORONAVIRUS SARS-CoV-2 INFECTION: expert consensus on guidance and prevention strategies for hospital pharmacists and the pharmacy workforce (2nd edition)[J]. Chin Pharm J (中国药学杂志), 2020, 55(4):268-277.
[7]
NATIONAL HEALTH COMMISSION of the People′s Republic of China. Clinical management of human infection with novel coronavirus(COVID-19) (Interim guidance v6) [EB/OL].[2020-02-19].http://www.nhc.gov.cn/xcs/zhengcwj/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
[8]
MUNICIAP HEALTH COMMISSION of Shanghai. Notice on further strengthening the supply and safe medication of clinical drugs in the near future [EB/OL]. [2020-01-22].
[9]
MINISTRY OF HEALTH of the People′s Republic of China. Notice on recommending 《Diagnosis and treatment guideline of SARS (2004 version)》[EB/OL]. [2005-05-25]. http://www.nhc.gov.cnyzygjs3573/200804/8538589dd6e9475dab3f77 fa0f69edf0.shtml.
[10]
HEMILA H. Vitamin C and SARS coronavirus[J]. J Antimicrob Chemother, 2003, 52(6):1049-1050.
[11]
GORTON H C, JARVIS K. The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections[J]. J Manipulative Physiol Ther, 1999, 22(8):530-533.
[12]
CHARAN J, GOYAL J P, SAXENA D, et al. Vitamin D for prevention of respiratory tract infections:a systematic review and Meta-analysis[J]. J Pharmacol Pharmacother, 2012, 3(4):300-303.
[13]
ARIHIRO S, NAKASHIMA A, MATSUOKA M, et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza and upper respiratory infection in patients with inflammatory bowel disease[J]. Inflamm Bowel Dis, 2019, 25(6):1088-1095.
[14]
AGLIPAY M, BIRKEN C S, PARKIN P C, et al. Effect of hgh-dose vs standard-dose wintertime vitamin D supplementation on viral upper respiratory tract infections in young healthy children[J]. JAMA, 2017,318(3):245-254.
[15]
URASHIMA M, MEZAWA H, NOYA M, et al. Effects of vitamin D supplements on influenza A illness during the 2009 H1N1 pandemic:a randomized controlled trial[J]. Food Funct, 2014, 5(9):2365-2370.
[16]
REES J R, HENDRICKS K, BARRY E L, et al. Vitamin D3 supplementation and upper respiratory tract infections in a randomized, controlled trial[J]. Clin Infect Dis, 2013, 57(10):1384-1392.
[17]
URASHIMA M, SEGAWA T, OKAZAKI M, et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren[J]. Am J Clin Nutr, 2010, 91(5):1255-1260.
[18]
NANRI A, NAKAMOTO K, SAKAMOTO N, et al. Association of serum 25-hydroxyvitamin D with influenza in case-control study nested in a cohort of Japanese employees[J]. Am J Clin Nutr, 2017, 36(5):1288-1293.
[19]
NATIONAL HEALTH COMMISSION of the People′s Republic of China. Notice on printing and distributing《Diagnosis and treatment guideline of influenza (revised, 2018)》[EB/OL]. [2018-11-19]. http://www. gov. cn/fuwu/2018-11/27/content_5343680. htm.
[20]
UYEKI T M, BERNSTEIN H H, BRADLEY J S, et al. Clinical practice guidelines by the infectious diseases society of America:2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza[J]. Clin Infect Dis, 2019, 68(6):e1-e47.
[21]
PUBLIC HEALTH ENGLAND. PHE guidance on use of antiviral agents for the treatment and prophylaxis of influenza(2019-2020)(Version 10.0 Public Health England) [EB/OL]. [2019-09-09] https://www.gov.uk/government/publications/influenza-treatment-and-prophylaxis-using-anti-viral-agents.
[22]
COLUNGA BIANCATELLI R M L, BERRILL M, MARIK P E. The antiviral properties of vitamin C[J]. Expert Rev Anti Infect Ther, 2020, 18(2):99-101.
[23]
CHANG X N, LI M, ZHANG Z X, et al. Effect of vitamin C on patients with sepsis and septic shock:a Meta-analysis[J]. Chin J Criti Care Med(中华危重症医学杂志:电子版), 2019, 12(1):37-41.
[24]
SUNDARAM M E, COLEMAN L A. Vitamin D and influenza[J]. Adv Nutr, 2012, 3(4):517-525.
[25]
TEYMOORI-RAD M, SHOKRI F, SALIMI V, et al. The interplay between vitamin D and viral infections[J]. Rev Med Virol, 2019, 29(2):e2032.
[26]
SU M, GUO C, LIU M, et al. Therapeutic targets of vitamin C on liver injury and associated biological mechanisms: a study of network pharmacology[J]. Int Immunopharmacol, 2019, 66:383-387.
[27]
GALIOR K, GREBE S, SINGH R. Development of vitamin D toxicity from overcorrection of vitamin D deficiency:a review of case reports[J]. Nutrients, 2018, 10(8):953.
2020, Vol. 55 
