Pediatric Pellagra Treatment & Management

Updated: Oct 04, 2018
  • Author: Simon S Rabinowitz, MD, PhD, FAAP; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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Medical Care

Nicotinamide or niacin taken orally is usually effective in reversing the clinical manifestations of pellagra. Because patients are often malnourished and suffer from other vitamin deficiencies, provision of a high-protein diet and B-complex vitamins is needed for complete restoration of health.

A recent study conducted on a rat model of pellagra has shown that administration of the niacin precursor, L-tryptophan (L-trp) is effective in preventing pellagra, but its safety for this use in humans is yet to be established. [21]

Treating patients with alcoholism who have multiple B vitamin deficiencies with a B complex that has inadequate amounts of niacin or with thiamine and pyridoxine therapy without niacin may aggravate the neurological state or trigger the development of alcoholic pellagra encephalopathy. [22]

RDA for infants and children

The recommended intake of 6.6 niacin equivalents per 1000 kcal daily is accepted for children aged 6 months or older. For infants up to 6 months, it is accepted that breastfeeding by well-nourished mothers supplies adequate niacin equivalents to fulfil the needs (ie, 8 niacin equivalents/1000 kcal) of this age group. [8]



In order to prevent and/or treat pellagra, provide a diet high in protein and adequate in calories. The addition of meats, milk, peanuts, green leafy vegetables, whole or enriched grains, and brewers' dry yeast can enhance the niacin intake. In patients with oral dysphagia secondary to glossitis, a liquid or a semisolid diet may be required. Long-term inclusion of milk, meat, and eggs in the diet ensures dietary adequacy of proteins essential for recovery.



Bed rest is mandatory in treatment of severe cases of pellagra.