A Randomized Controlled Trial of Zinc as Adjuvant Therapy for Severe Pneumonia in Young Children

Abstract

BACKGROUND AND OBJECTIVE: Diarrhea and pneumonia are the leading causes of illness and death in children <5 years of age. Zinc supplementation is effective for treatment of acute diarrhea and can prevent pneumonia. In this trial, we measured the efficacy of zinc when given to children hospitalized and treated with antibiotics for severe pneumonia. METHODS: We enrolled 610 children aged 2 to 35 months who presented with severe pneumonia defined by the World Health Organization as cough and/or difficult breathing combined with lower chest indrawing. All children received standard antibiotic treatment and were randomized to receive zinc (10 mg in 2- to 11-month-olds and 20 mg in older children) or placebo daily for up to 14 days. The primary outcome was time to cessation of severe pneumonia. RESULTS: Zinc recipients recovered marginally faster, but this difference was not statistically significant (hazard ratio = 1.10, 95% CI 0.94–1.30). Similarly, the risk of treatment failure was slightly but not significantly lower in those who received zinc (risk ratio = 0.88 95% CI 0.71–1.10). CONCLUSIONS: Adjunct treatment with zinc reduced the time to cessation of severe pneumonia and the risk of treatment failure only marginally, if at all, in hospitalized children.

Vitamin D status is associated with treatment failure and duration of illness in Nepalese children with severe pneumonia

“…The primary objective of this RCT was to measure the effect of up to 14 days of daily zinc supplementation on time to recovery from severe pneumonia and treatment failure. These results, and predictors for treatment failure and cessation of severe pneumonia, have been described elsewhere (21,22). The study included children aged 2-35 months with severe pneumonia who were referred to Kanti Children´s hospital Emergency or Outpatient departments.…”

“…The children were discharged with advice to the parents to continue amoxicillin and to complete antibiotic treatment of a total of 10 days. Details of both inclusion and exclusion criteria are described previously (21) and are listed in Figure 1.…”

“…The completed forms with patient data were collected daily by study assistants and the data were entered twice continuously into a relational database. A detailed description of the data collection, the laboratory and technical equipment used, and the treatment given have been presented elsewhere (21).…”

Zinc as an adjunct to antibiotics for the treatment of severe pneumonia in children <5 years: a meta-analysis of randomised-controlled trials

“…The supplementation duration was 5-14 d or until discharge from a hospital. For primary outcomes, eight studies (9,10,(12)(13)(14)(15)(16)(17) reported time to recovery from severe pneumonia, with five (9,(12)(13)(14)(15) reporting HR and 95 % CI; five (9,10,(14)(15)(16) reported HLOS, with three (9,14,15) reporting HR and 95 % CI; six (9,12,(14)(15)(16)(17) reported treatment failure; and five (9,12,14,16,17) reported change of antibiotics.…”

“…Among the thirteen studies, four were excluded, of which one (23) was an advanced abstract of an included study, two (24,25) focused on children with severe acute lower respiratory tract infection (LRTI) but not severe pneumonia and one (26) used the same data from the included trial. Finally, nine RCT (9)(10)(11)(12)(13)(14)(15)(16)(17) were included.Baseline characteristics and risk of bias …”