Zinc Supplementation in Severe Acute Lower Respiratory Tract Infection in Children: A Triple-Blind Randomized Placebo Controlled Trial
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To evaluate the efficacy of zinc supplementation on duration of illness in children with severe acute lower respiratory tract infection (ALRTI).
This randomized triple-blind placebo-controlled trial was conducted in pediatric emergency of a teaching referral hospital. Children in the age group of 2–24 months presenting to pediatric emergency with severe ALRTI were included. Eligible children were randomly allocated to zinc (n = 53) or control (n = 53) groups. Zinc group received 20 mg of elemental zinc per day (5 ml syrup per day) as a single daily dose for 5 days. Control group received an equal amount of placebo which was appropriately modified to give the taste, smell, color and consistency similar to zinc mixture. Primary outcome was ‘time to be asymptomatic’, a composite outcome defined as resolution of all four of the following: danger signs, respiratory distress, tachypnea and hypoxia in room air.
Age, gender, nutritional status, pretreatment zinc levels and other demographic and clinical variables were similar in the two groups. ‘Time to be asymptomatic’ was comparable in the two groups (h; median (IQR): 60 (24–78) vs. 54 (30–72), P = 0.98]. At any time point a similar proportion of children were symptomatic in both the groups. Time to resolution of respiratory distress, tachypnea, dangers signs and hypoxia were also similar in two groups. Duration of hospital stay was shorter by 9 h in the zinc group but the difference was statistically insignificant.
Zinc supplementation did not reduce recovery time and duration of hospital stay in children with ALRTI. Larger randomized controlled trials are needed to evaluate role of zinc in ALRTI.
- World Health Organisation. Global Action Plan for the Prevention and Control of Pneumonia (GAPP). Report of an informal consultation, La Mainaz, Gex, France: March 5–7, 2007.
- Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of causes of death in children. Lancet. 2005;365:1147–52. CrossRef
- Sazawal S, Black RE. Meta-analysis of intervention trials on case management of pneumonia in community settings. Lancet. 1992;340:528–33. CrossRef
- Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J ClinNutr. 1998;68:447S–63.
- Bhatnagar S, Chandra U, Natchu M. Zinc in child health and disease. Indian J Pediatr. 2004;71:991–4. CrossRef
- Bahl R, Bhandari N, Hambridge KM, Bhan MK. Plasma zinc as a predictor of diarrhoeal and respiratory morbidity in children in urban slum setting. Am J Clin Nutr. 1998;68 suppl 2:414S–7.
- Bhutta ZA, Bird SM, Black RE, et al. Therapeutic effects of oral zinc in acute and persistent diarrhoea in children in developing countries: pooled analysis of randomised controlled trials. Am J Clin Nutr. 2000;72:1516–22.
- Mahalanbis D, Bhan MK. Micronutrients as adjunct therapy of acute illness in children: impact on episode outcome and policy implications of current findings. Br J Nutr. 2001;85:S151–8. CrossRef
- Bhutta ZA, Black RE, Brown KH, et al. Prevention of diarrhoea and pneumonia by zinc supplementation in developing countries: pooled analysis of randomized controlled trials: zinc investigator’s collaborative group. J Pediatr. 1999;135:689–92. CrossRef
- Aggarwal R, Sentz J, Miller MA. Role of zinc administration in prevention of childhood diarrhea and respiratory illnesses: a meta-analysis. Pediatr. 2007;119:1120–30. CrossRef
- Brooks WA, Yunus M, Santosham M, et al. Zinc for severe pneumonia in very young children: double blind placebo controlled trial. Lancet. 2004;363:1683–8. CrossRef
- Mahalanbis D, Lahiri M, Paul D, et al. Randomised double blind placebo controlled clinical trial of the efficacy of treatment with zinc or vitamin A in infants and young children with severe ARI. Am J Clin Nutr. 2004;79:430–6.
- Bose A, Coles CL, Gunavathi, et al. Efficacy of zinc in treatment of severe pneumonia in hospitalized children <2 years old. Am J Clin Nutr. 2006;83:1089-96.
- Chang AB, Torzillo PJ, Boyce NC, et al. Zinc and vitamin A supplementation in indigenous Australian children hospitalized with lower respiratory tract infection: a randomized controlled trial. Med J Aust. 2006;184:107–12.
- Sazawal S, Black RE, Bhan MK, Bhandari N, Sinha A, Jalla S. Zinc supplementation in young children with acute diarrhea in India. N Eng J Med. 1995;333:839–44. CrossRef
- Sazawal S, Benltey M, Black RE, Dhingra P, George S, Bhan MK. Effect of zinc supplementation on observed activity in low socio- economic Indian pre-school children. Pediatrs. 1996;98:1132–7.
- Bogden JD. Influence of zinc on immunity in the elderly. J Nutr Health Aging. 2004;8:48–54.
- Zinc Supplementation in Severe Acute Lower Respiratory Tract Infection in Children: A Triple-Blind Randomized Placebo Controlled Trial
The Indian Journal of Pediatrics
Volume 78, Issue 1 , pp 33-37
- Cover Date
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- Online ISSN
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- Respiratory tract infection
- Industry Sectors
- Author Affiliations
- 1. Department of Pediatrics, Government Medical College Hospital, Chandigarh, India
- 2. Department of Biochemistry, Government Medical College Hospital, Chandigarh, India