In 2017, a paper was published asserting that intravenous vitamin C given to patients with sepsis was a life saver. Despite the fact the study only looking at 47 subjects, the results garnered international coverage and the treatment was adopted in many ICUs worldwide.
The author, Dr. Paul Marik, from the Eastern Virginia Medical School in the US, used Vitamin C with thiamine and steroids regularly to treat patients with sepsis in his intensive care unit, reporting that the mortality rate had plummeted after he switched to this treatment.
What became known as the "Marik protocol" has been adopted by many units worldwide.
But a new study involving ten intensive care units in Australia, New Zealand and Brazil led by Professor Rinaldo Bellomo, from Monash University and Co-Director of the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), refutes the idea that this vitamin and steroid cocktail is beneficial in the treatment of sepsis.
The VITAMINS trial, published in the Journal of the American Medical Association, was set up by the ANZIC-RC , looking at 211 patients in septic shock between May, 2018 and July, 2019.
The patients were randomised to either the intervention group (receiving intravenous vitamin C, hydrocortisone and thiamine) or the control group (receiving hydrocortisone only).
The study found no improvement in the duration of support with blood pressure drugs for the treatment of shock or survival of those receiving vitamin C + thiamine + steroid therapy compared to steroid therapy alone.
According to Professor Bellomo, the study provides high quality evidence that, in patients with septic shock, the combination of high dose intravenous vitamin C, thiamine and hydrocortisone is not superior to usual care with hydrocortisone alone.
He says: "The findings of the VITAMINS trials are clear: in patients with septic shock from Australia, New Zealand and Brazil there was no signal of benefit with the high dose vitamin C, thiamine and hydrocortisone cocktail. The search for treatments that might improve the outcome of these very sick patients must now focus on other interventions."
Source: Journal of the American Medical Association
Bellomo. R., et al
"Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic ShockThe VITAMINS Randomized Clinical Trial"
doi:10.1001/jama.2019.22176