Efficacy of alternate day versus daily oral iron therapy in children with iron deficiency anemia: a randomized controlled trial.

Background: Iron deficiency anemia (IDA) is the leading cause of nutritional anemia. In some cases, oral iron therapy (OIT) fails to achieve an optimal therapeutic response. Oral doses of iron acutely increase serum hepcidin, resulting in decreased iron absorption and poor response treatment.

Objective: The primary objective was to assess the efficacy of alternate-day versus twice-daily OIT in children with IDA. The secondary objective was to study the effects of alternate versus twice-daily OIT on serum hepcidin levels and to compare gastrointestinal side effects between groups.

Methods: This was an RCT of 40 IDA patients, aged 6 months 10 years. The first group received twice-daily OIT, and the second group received alternate-day OIT. Serum hepcidin levels were measured at baseline and 48 h after starting OIT. Changes in hemoglobin level were noted after 30 days.

Results: Patients who received alternate-day OIT had increase hemoglobin (P = 0.002) and decrease serum hepcidin (P = 0.01). Four of twenty in the alternate-day group (20%) had gastrointestinal side effects (P = 0.01).

Conclusion: Children who received alternate-day OIT had lower serum hepcidin levels, which resulted in better iron absorption and compliance, significant improvement in hemoglobin levels, and fewer gastrointestinal side effects.