Clinical scenario

A 56 year old man attends the emergency department with cellulitis in his left leg. He is unkempt and drinks heavily. The cellulitis can be treated as an outpatient with oral antibiotics, but you suspect he is thiamine deficient as a result of long term alcohol misuse. You are therefore about to prescibe an intravenous infusion of thiamine as you have always given it this way. This will commit you to an inpatient admission and beds are at a premium.You wonder whether there is any basis for your prescribing practice—perhaps oral thiamine would be just as effective.

Three part question

In [thiamine deficient patients without Wernickes encephalopathy] is [parenteral delivery of thiamine better than the oral route] at [achieving bioavailability without side effects]?

Search strategy

Medline 1966-03/04 using the OVID interface. [(exp thiamine OR thiamine.af OR (vitamin adj5 b1).af) AND (exp infusions, intravenous/OR exp injections, intravenous OR intravenous.af OR exp infusions, parenteral OR parenteral.af) AND (exp administration, oral OR oral.af OR exp tablets OR tablet.af OR po.af)] LIMIT to human AND English Language.

Search outcome

Altogether 25 papers were found of which two were relevant to the three part question (table 4).

Comment(s)

Clearly concordance with treatment also has to be considered. This has not been considered at all in the papers found.

CLINICAL BOTTOM LINE

Oral thiamine administration is as effective as parenteral administration after five days. In compliant alcoholics without encephalopathy oral administration is the route of choice.