Aim To optimise fat soluble vitamin supplementation in children with CF in a tertiary children’s hospital and primary care. To compare supplementation of individual vitamins and supplementation with a new multivitamin preparation against national guidelines, cost and patient acceptability.¹

Methods Comparison of current practice (supplementation of individual vitamins) with a new multi-vitamin preparation, Paravit-CF. Form and dose of each of the fat soluble vitamins was compared against national CF Trust guidelines for nutrition.¹ Cost of treatment per day was compared. Patient acceptability was explored by comparing medication burden and with a focus group made up of representatives from the CF multi-disciplinary team (MDT) including, consultants, specialist nurses, dieticians and a pharmacist.

Results Current approach to vitamin supplementation is not in line with the CF Trust guidelines for nutrition. Supplementation with Paravit-CF preparations meets recommendations made in the CF Trust guidelines for nutrition for patients of all ages except for infants. Infants will receive vitamin A at higher doses than recommended. Cost of vitamin supplementation is reduced by approximately 50% when using Paravit-CF compared with current practice. Medication burden is reduced by more than 50% when using Paravit-CF compared with current practice. Main themes from the MDT focus group were that Paravit-CF liquid is colourless, taste free, odour free and can be mixed into food, all of which may aid compliance. Paravit-CF preparations also vegetarian friendly and comply with halal and kosher regulations. Unlike current practice, Paravit-CF does not offer flexibility in dosing of individual vitamins.

Conclusion Fat soluble vitamin supplementation using Paravit-CF offers several advantages over supplementation of individual vitamins. Paravit-CF offers vitamin supplementation at doses in line with the recommendations made by the CF Trust, is cheaper and reduces the medication burden for patients. Locally, the decision has been made to switch to Paravit-CF as first line vitamin supplementation in children with CF. Future work is planned to assess clinical efficacy and financial impact of the switch.

Reference

1. Cystic Fibrosis Trust. Nutritional Management of Cystic Fibrosis. Second Edition. September 2016. Available from: https://www.cysticfibrosis.org.uk/the-work-we-do/clinical-care/consensus-documents (Accessed 10 July 2018)