Comparison Between Once Weekly, Twice Weekly, and Daily Oral Iron Therapy in Jordanian Children Suffering From Iron Deficiency Anemia

Abstract

The efficacy of daily versus twice weekly and once weekly oral iron therapy was analyzed to optimize a protocol for treatment of IDM among Jordanian children. One hundred and forty-eight children aged between 6 and 60 months with Hb estimate less than 11 gm/dl were screened. They were randomly divided into three regimens of oral iron therapy for a period of 12 weeks; a group was supplemented with a single weekly dose of iron; a second group received two doses weekly; and a third group had a daily dose of iron. Hb was assayed 3 and 12 weeks after therapy, while ferritin was assayed after 12 weeks of treatment. A significant rise in Hb concentration was observed which was most significant 12 weeks after treatment. Iron supplementation after 3 weeks was similar in all treated groups, and no significant difference in Hb concentration among the three groups was noticed. By the end of the third week, the anemia had respectively resolved by 18, 11.8 and 23.4% in the daily, twice weekly, and once weekly groups. On the other hand, the percentage of recovery of anemia respectively was 78, 90.2 and 74.5% at the end of 12 weeks of iron therapy. Hb recovery percentage was comparable in the three treated groups, and no significant difference was reported between them either at 3 or at 12 weeks of therapy. Ferritin levels in the daily and twice weekly treated groups were similar after 12 weeks of iron therapy and were significantly higher than the ferritin levels of weekly treated group. Although the anemia in the three treated groups was resolved after 3 and 12 weeks of oral iron therapy, we conclude that the regimen of two doses per week is the most effective in resolving anemia with less cost and fewer side effects.

Oral Iron Supplementation—Gastrointestinal Side Effects and the Impact on the Gut Microbiota

“…Experimental evidence suggests that taking iron two to three times a day may not be the best way to take iron supplements despite it being the current guidelines. Moretti et al 2015 [33] found that high doses of oral iron supplements cause an increase in hepcidin, which inhibits iron absorption for up to 24 h. They found that dosing 48 h apart enhanced iron absorption compared to three daily doses as it allows sufficient time for hepcidin levels to decrease and remove the mucosal block on absorption [34,35]. Other groups have also confirmed enhanced iron absorption with single dosing once daily or alternate day dosing [33,34,36].…”

“…Overall, changing the formulation of iron supplementation reduces side effects by lowering the dosage and, in turn, reduces the amount of unabsorbed iron in the GI tract. It appears the best way to restore iron levels with the least number of side effects is with fewer doses of iron (even just two doses per week), which would also be more cost effective [35].…”

Micronized, Microencapsulated Ferric Iron Supplementation in the Form of >Your< Iron Syrup Improves Hemoglobin and Ferritin Levels in Iron-Deficient Children: Double-Blind, Randomized Clinical Study of Efficacy and Safety

“…Hb value may normalize on a small daily dose of iron, but this low dose seldom suffices for metabolic needs or the replenishment of iron stores in the body [13]. Similar studies of iron supplementation in children have reported higher efficacies within a 3-month supplementation period; however, much higher doses of iron (ranging from 2 mg/kg of iron per body weight per day to 6 mg/kg of iron per body weight per day) than the one applied in our study have been used [14][15][16]. Of particular importance, these studies were all performed in anemic subjects, whereas our study included children with ID without anemia.…”

The Evaluation of Taking Iron Supplements in Children Aged 6 Months-2 Years

“…Profilaktik olarak kullanılan demir günlük olarak oral yolla verilmektedir (günlük demir profilaksisi). Son zamanlarda intermitan demir profilaksisi olarak adlandırılan haftada bir veya iki kez demir kullanımının da etkin olduğunu bildiren çalışmalar yayınlanmaktadır (13)(14)(15)(16). Oral yoldan alınan demirin ilk dozundan sonra enterositlerden demir ve diğer minerallerin emiliminin geçici olarak blokaja uğramasından dolayı günlük demir kullanımı ile intermitan demir kullanımlarının benzer şekilde barsaktan emildiğini bildiren çalışmalar vardır (17,18).…”