Abstract
Background
Zinc deficiency has been associated with an increased risk of gastrointestinal infections, adverse effects on the structure and function of the gastrointestinal tract, and impaired immune function. Recently, oral zinc therapy has been added to the standard treatment of diarrhoea by the World Health Organization, as it can improve outcomes in paediatric patients with diarrhoea, especially those in developing countries.
Methodology
A randomized open-label multicentre study was conducted in 100 paediatric patients with diarrhoea. Patients were randomized to the control group (received standard treatment for diarrhoea, such as oral rehydration solution [ORS], intravenous fluids, and antibiotics as required) or the zinc study group (received standard treatment plus oral zinc sulfate). Patients were followed up until recovery and collection of necessary data.
Results
Of the 100 children enrolled in the study, 50 % were aged 1–5 years and 50 % were aged <1 year. In the overall population, children were treated with ORS (67 %), intravenous fluids (50 %) and antibiotics (77 %). The mean frequency of diarrhoea episodes was significantly (p < 0.05) lower in the zinc group than in the control group on day 4 of illness, but not on days 1, 2 and 3. All patients recovered on day 4 in the zinc group, while nine patients required treatment on day 5 in the control group (p < 0.05).
Conclusion
In young children with diarrhoea, the addition of oral zinc supplementation to standard anti-diarrhoeal therapy may reduce the time to resolution of diarrhoea relative to standard treatment alone in developing countries.
Similar content being viewed by others
References
Bajait C, Thawani V. Role of zinc in paediatric diarrhoea. Indian J Pharmacol. 2011;43:232–5.
Dipiro JT, Schwinghammer T, et al. Pharmacotherapy: a pathophysiologic approach. 6th ed. Oklahoma: The McGraw-Hill Companies; 2005.
Celia CC, Mediadora CS. Etiology and epidemiology of diarrhoea. Phil J Microbiol Infect Dis. 1990;19:51–3.
Bhatnagar S, Lodha R, Choudhury P, et al. IAP guidelines 2006 on management of acute diarrhoea. Indian Pediatr. 2007;44:380–9.
Semard CE. Zinc and intestinal function. Curr Gastroenterol Rep. 1999;1:398–403.
The treatment of diarrhea: a manual for physicians and other senior health workers. Maternal, newborn, child and adolescent health. World Health Organisation (WHO). [cited on January 2014] Available from: http://www.who.int/maternal_child_adolescent/documents/9241593180/en/.
New formulation of oral rehydration salts (ORS) with reduced osmolarity. UNICEF. 2009. [cited on November 2013] Available from: http://rehydrate.org/ors/low-osmolarity-ors.htm.
Walker CLF, Fontaine O, Young MW, et al. Zinc and low osmolarity oral rehydration salts for diarrhoea: a renewed call to action. Bull World Health Organ. 2009;87:780–6.
Bhutta ZA, Bird SM, Black RE, et al. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: pooled analysis of randomized controlled trials. Am J Clin Nutr. 2000;72:1516–22.
Diarrhoea treatment guidelines: including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare workers. MOST: the USIAD micronutrient program, WHO; 2005. [cited on November 2013] Available from: http://whqlibdoc.who.int/publications/2005/a85500.pdf.
Baqui AH, Black RE, El Arifeen S, et al. Effect of zinc supplementation started during diarrhoea on morbidity and mortality in Bangladeshi children: community randomized trial. BMJ. 2002;325:1059.
Bhatnagar S, Bahl R, Sharma PK, et al. Zinc treatment with oral rehydration therapy reduces stool output and duration of diarrhoea in hospitalized children; a randomized controlled trial. J Pediatr Gastroenterol Nutr. 2004;38:34–40.
Bhatnagar S, Lodha R, Choudhury P, et al. IAP guidelines 2006 on management of acute diarrhoea. Indian Pediatr. 2007;44:380–9.
Bhan MK, Bhandari N. The role of zinc and vitamin A in persistent diarrhea among infants and young children. J Pediatr Gastroenterol Nutr. 1998;26:446–53.
Maret W, Sandstead HH. Zinc requirements and the risks and benefits of zinc supplementation. J Trace Elem Med Biol. 2006;20:3–18.
Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2013;(1):CD005436.
Robbestad B, Strand T, Black RE. Cost-effectiveness of zinc as adjunct therapy for acute childhood diarrhoea in developing countries. Bull World Health Organ. 2004;82:523–31.
Roy SK, Raqib R. Zinc supplementation in the management of shigellosis in malnourished children in Bangladesh. Eur J Clin Nutr. 2008;62:849–55.
Shimelis D, Benti D, Challi D. Effect of zinc supplementation in treatment of acute diarrhoea among 2–59 months children treated in Black Lion Hospital, Ethiopia. Ethiop J Health Dev. 2008;22:187–90.
Oral rehydration salts: production of the new ORS. World Health Organization child and adolescent health and development; 2006. p. 89.
Improved formula for oral rehydration salts to save children’s lives. Media centre. New York/Geneva: World Health Organization; 2006. [cited on December 2013] Available from: http://www.who.int/mediacentre/news/releases/2006/pr14/en/index.html.
Duggan C, Fontaine O, Pierce NF, et al. Scientific rationale for a change in the composition of oral rehydration solution. JAMA. 2004;291:2628–31.
Acknowledgments
For permission to conduct the study in their hospital premises, the authors would like to thank Dr N. Kharod (Pramukhswami Medical College, Karamsad), and Drs M. A. Meman, K. Shah and P. Mehta from the Anand district.
Disclosure
No sources of funding were used to conduct this study or prepare the manuscript. The authors have no conflicts of interest that are directly relevant to the content of this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Patel, H.N., Shah, R.B. & Gajjar, B.M. Evaluation of the role of zinc supplementation in treatment of diarrhoea in paediatric patients: a randomized open-label study. Drugs Ther Perspect 31, 34–38 (2015). https://doi.org/10.1007/s40267-014-0169-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40267-014-0169-6