European Journal of Cardiovascular Medicine

Urinary tract infection often presents as the clinical syndromes of acute uncomplicated urinary infection including acute non obstructive pyelonephritis; complicated urinary tract infection; asymptomatic bacteriuria; and, in men, bacterial prostatitis. Complicated urinary infection frequently results in a severe or life-threatening infection. Both men and women who have anatomical or functional abnormalities of the urinary tract might develop complicated urine infections. The most frequent initiating factors for urosepsis are obstruction or mucosal injuries. Although 20 to 30 percent of men with acute bacterial prostatitis or women with acute no obstructive pyelonephritis develop bacteremia, these illnesses seldom worsen to severe sepsis or shock¹. Vesicoureteral reflux (VUR)². obstructive uropathy, the frequency of acute pyelonephritis flare-ups (APN), and delaying the treatment of acute infection are risk factors for renal parenchymal damage in UTIs^3,4.

Since 1920, Vitamin A has been known as an anti-infective vitamin⁵. Vitamin A has long been recognized as a crucial component in combating infections, a reputation dating back to the 1920s⁶. Vitamin A deficiency mimics immunodeficiency disorders in which there are disturbances in immunity, including pathological alterations in mucosal surfaces, impaired antibody responses to protein antigens, changes in lymphocyte subpopulations and altered T- and B-cell function^7,8. Vitamin A was proposed as effective in the regeneration of epithelial tissue in the urinary tract⁹. Given the significance of mucosal immunity in urinary tract infections (UTIs),¹⁰ it's noteworthy that while numerous clinical trials have underscored the positive correlation between vitamin A supplementation and reduced mortality and morbidity rates associated with conditions like measles, diarrhea, and respiratory illnesses, there remains a gap in data regarding the relationship between recurrent UTIs (RUTIs) and vitamin A status^11,12,13 Following Block's proposal that vitamin A deficiency exacerbates UTIs, there has been limited exploration of the vitamin's relationship with UTIs¹⁴. Brown et al. highlighted the beneficial impact of vitamin A on epithelialization, suggesting a preventive role against infections¹⁵.

Although various studies demonstrate a positive relationship between vitamin A supplementation and decreased mortality and morbidity rates from measles, diarrhoea and respiratory diseases, there are very few data available on the relationship between urinary tract infections (UTI) and vitamin A status^16,17. Therefore this study was planned to evaluate the efficacy of co-administration of Vit-A in treating Urinary Tract Infections over the standard regular treatment without adding Vit-A in a tertiary care hospital.

This observational study was conducted at the Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondicherry, over a period of six months, from January 2025 to June 2025. About hundred urinary tract infection patients attending the General Medicine OPD were included in the study divided into two groups “A” & “B” and group A treated with standard UTI treatment with Vit-A supplementation where as group B treated with only standard UTI treatment and the efficacy of the treatment was compared. The objects were framed as:

1. To determine the socio-demographic profiles of the study subjects
2. To assess the efficacy of the co-administration of vitamin-A in treating Urinary Tract Infections.

After obtaining ethical committee clearance, data was collected using a pretested proforma, including Socio-demographic profiles like age & sex, weight, h/o Hypertension and Diabetes, distribution of clinical symptoms and duration of hospital stay etc; and the collected data was analyzed using statistical tools, including: Percentages and proportions, Measures of central tendency and dispersion, Standard error of the mean, Correlation coefficient,Tests of significance etc; The study results were compared in the light of published literature of various authors  and discussed to draw conclusions and recommendations.

Table 1:  DISTRIBUTION OF DEMOGRAPHIC PROFILES OF STUDY SUBJECTS

Group A Mean ± SD = 39.7±16 Vs Group B Mean ± SD = 40.5±14

• Significant matching was observed between the two groups. And maximum number of study subjects was observed between 21-30 years of age group among both the groups (group A 42% & group B 38%). About maximum 72% of the study subjects were married among both the groups

Table 2: Effectiveness of Co-administration of Vitamin-A in treating UTI in relation to Clinical features

• It was observed that with regard to signs & symptoms cloudy urine and increased frequency was significantly (P<0.05) decreased among group A patients when compared to group B.

Table 3: Effectiveness of Co-administration of Vitamin-A in terms of other factors

• With reference to other features there was significant (P<0.05)difference observed among group A patients regard to Duration of hospital stay and Average duration of negative urine culture etc;

Figure 2: Duration of hospital stay between the two group

This study observed a similar distribution (matching) among both groups regarding age, weight and marriage. And maximum number of study subjects was observed between 21-30 years of age group among both the groups (group A 42% & group B 38%) with the mean About maximum 72% of the study subjects were married among both the groups. Our analysis revealed significant differences in certain clinical outcomes between the two groups. Notably, the frequency of urination and incidence of cloudy urine were markedly improved in Group A, suggesting that vitamin A supplementation might play a role in alleviating some UTI symptoms. These findings align with Kahbazi et al. (2019)¹⁸, who demonstrated that vitamin A supplementation could significantly reduce the duration of fever and urinary frequency, further corroborating vitamin A's potential in enhancing the standard UTI treatment regimen.

Moreover, the duration for achieving a negative urine culture was notably shorter in Group A, indicating a faster microbial clearance rate. This outcome suggests that vitamin A might enhance the antimicrobial efficacy of standard therapy, an aspect that parallels findings from Yilmaz et al. (2007)¹⁹, where vitamin A supplementation was associated with a reduced infection rate in the initial six months of follow-up. In our study, the eradication rate of UTIs was higher in the group receiving vitamin A supplementation. These findings suggest a potential explanation for the observed outcomes lies in the immunoregulatory effects of vitamin A. Vitamin A exerts dual effects on the immune system: it enhances the effectiveness of immune responses to infections after the epithelial barrier has been breached and boosts non-specific immunity by preserving the integrity of epithelial tissue, the body's primary defense against infections.^20,21 Evidence indicates that vitamin A depletion reduces the antibody response to Streptococcus pneumonia’s capsular polysaccharide, a response that is restored upon vitamin A replenishment²². Additionally, Jurin and Tannock et al proposed that vitamin A may act as an immune response adjuvant, potentially enhancing macrophage functions²³ Furthermore, vitamin A is known to regulate the expression of numerous genes and plays a crucial role in T-cell differentiation²⁴. Previous studies have shown that retinoic acid, a derivative of vitamin A, increases the percentage of peripheral blood lymphoid cells expressing surface markers for T-helper cells while minimally affecting natural killer cell marker expression, whereas β-carotene, another form of vitamin A, augments the percentage of cells expressing natural killer cell markers with a smaller impact on T-helper markers²⁵.  These collective mechanisms may contribute to the observed decrease in UTI recurrence rates following vitamin A supplementation as observed in our study in correlation to Yilmaz A et al¹⁹ study. And also in some studies like Sobouti B et al²⁶ & Avazi P et al²⁷ were observed that co- administration of Vitamin - A has significantly prevented the permanent renal damage & reduced the renal scarring in their studies. Although none of our patients exhibited clinical signs of vitamin A deficiency, seven patients had lower levels than reference values. Serum vitamin A levels increased in all patients throughout the study period, which we presumed to be related to vitamin A supplementation.

LIMITATIONS

The hospital-based design and small sample size of this study may limit the generalizability of the findings to the broader population.

The co-administration of vitamin A with standard treatment for UTIs presents a promising approach to enhance treatment efficacy, reduce symptomatology, and potentially mitigate the risk of renal scarring. Our findings, corroborated by existing literature, suggest a beneficial role for vitamin A supplementation in UTI management. However, the journey from promising preliminary data to established clinical practice necessitates rigorous, evidence-based investigations to fully ascertain the therapeutic potential and safety profile of vitamin A in this context. Therefore, healthcare providers should consider incorporating vitamin A supplementation as an adjunct therapy in the management of UTIs, particularly in cases where patients exhibit symptoms such as frequency of urination and cloudy urine with Regular follow-up appointments should be scheduled to assess adherence to drugs & Vit-A supplementation, response to treatment, recurrence of UTIs, and duration of hospital stay etc; This proactive approach allows for timely adjustments to treatment plans and ensures optimal patient care.

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