Role of zinc in severe pneumonia: a randomized double bind placebo controlled study

Shah, G. L.; Dutta, A. K.; Shah, Dheeraj; Mishra, Om P.

doi:10.1186/1824-7288-38-36

Cited by 42 publications

(42 citation statements)

References 11 publications

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“…A total of thirteen studies remained after screening titles/abstracts. 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.…”

Section: Literature Searchmentioning

confidence: 99%

“…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.…”

Section: Baseline Characteristics and Risk Of Biasmentioning

confidence: 99%

“…Furthermore, other meaningful outcomes, such as treatment failure, change of antibiotics, death, vomiting and clinical deterioration, were also analysed. Basnet (2012) Bose (2006) Bose (2006) Bose (2006) Brooks (2004) Brooks (2004) Brooks (2004) Brooks (2004) Valentiner-Branth (2010) Valentiner-Branth (2010) Valentiner-Branth (2010) Wadhwa (2013) Wadhwa (2013) Wadhwa ( (9,11,14,16,17) 5 1414 0 0·41 0·03 −0·07, 0·14 0·53 Time to recovery from chest indrawing (9,14,17) 3 961 14 0·31 −0·07 −0·20, 0·07 0·33 Time to recovery from fever (10,11,14) 3 774 68 0·05 −0·14 −0·40, 0·12 0·29…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…In addition, a relatively large-sample RCT with 610 children found that Zn supplement could reduce the duration of severe pneumonia and the incidence of treatment failure only marginally but not statistically significantly (12) . Moreover, some other RCT suggested that adjunct treatment with Zn failed to show any beneficial effect in children with severe pneumonia (13)(14)(15)(16)(17) .Abbreviations: HLOS, hospital length of stay; RCT, randomised-controlled trial; RR, relative risk; HR, hazard ratio; SMD, standard mean difference; LRTI, lower respiratory tract infection. Given the controversial effect of Zn and accumulating evidence from RCT, a meta-analysis is warranted (12) .…”

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

et al. 2016

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The effect of Zn, as an adjunct to antibiotics, on the treatment of severe pneumonia in young children is still under debate; therefore, we performed a meta-analysis to evaluate the therapeutic role of Zn for severe pneumonia in children younger than 5 years. PubMed, Cochrane library and Embase databases were systematically searched from inception until October 2015 for randomised-controlled trials (RCT) that assessed the effect of Zn as an adjunct to antibiotics for severe pneumonia. Random-effects model was used for calculating the pooled estimates, and intention-to-treat principle was also applied. Nine RCT involving 2926 children were included. Overall, the pooled results showed that adjunct treatment with Zn failed to reduce the time to recovery from severe pneumonia (hazard ratios (HR) = 1·04; 95 % CI 0·90, 1·19; I 2 = 39 %; P = 0·58), hospital length of stay (HR = 1·04; 95 % CI 0·83, 1·33; I 2 = 57 %; P = 0·74), treatment failure (relative risk (RR) = 0·95; 95 % CI 0·79, 1·14; I 2 = 20 %; P = 0·58) or change of antibiotics (RR = 1·07; 95 % CI 0·79, 1·45; I 2 = 44 %; P = 0·67). In addition, continuous outcomes were consistent while meta-analysed with standard mean difference, and all outcomes remained stable in intention-to-treat analysis. No significant differences were observed in the two groups between death rate, adverse events or recovery times of severe pneumonia indicators. Our results suggested that adjunct treatment with Zn failed to benefit young children in the treatment of severe pneumonia. Considering the clinical heterogeneity, baseline characteristics of children, definition of severe pneumonia and Zn supplement way should be taken into consideration in future research. This study was registered at PRESPERO as CRD42015019798.Key words: Children: Meta-analyses: Severe pneumonia: ZincPneumonia is a leading disease and cause of death in children under 5 years in developing countries (1) . It is reported that 14·9 % of 6·3 million deaths of children <5 years old were caused by pneumonia worldwide (2) . With advances in medicine, economy and society, pneumonia with diarrhoea and measles was responsible for half of the reduction in mortality of children under 5 years from 2000 to 2013 (2) . Although great progress was achieved, only a few countries could reach the goal of Millennium Development Goal 4 to reduce under 5 child mortality by two-thirds between 1990 and 2015, and pneumonia is still the leading cause of child mortality (3) . Therefore, intensive effort should be made in the research of pneumonia.Under-nutrition has been reported to be strongly associated with impaired immune response, (4) and it has been proven to be responsible for greater severity of pneumonia, prolonged course of disease and increased mortality of pneumonia (5) .Zn, as an important micro-element, has an essential role in cellular growth and immune defence, and its deficiency is associated with significant increased susceptibility to various infection pathogens (6)(7)(8) . In a randomised-controlled trial (RCT...

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Section: Literature Searchmentioning

confidence: 99%

Section: Baseline Characteristics and Risk Of Biasmentioning

confidence: 99%

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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Zinc supplements for preventing otitis media

Gulani

Sachdev

2014

Cochrane Database of Systematic Reviews

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RETRACTED ARTICLE: Do Zinc Supplements Enhance the Clinical Efficacy of Hydroxychloroquine?: a Randomized, Multicenter Trial

Abd-Elsalam

Soliman

Esmail

et al. 2020

Biol Trace Elem Res

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No specific treatment for COVID-19 infection is available up till now, and there is a great urge for effective treatment to reduce morbidity and mortality during this pandemic. We aimed to evaluate the effect of combining chloroquine/hydroxychloroquine (CQ/HCQ) and zinc in the treatment of COVID-19 patients. This was a randomized clinical trial conducted at three major University hospitals in Egypt. One hundred ninety-one patients with a confirmed diagnosis of COVID-19 infection were randomized into two groups: group I (96) patients received both HCQ and zinc, and group II (95) received HCQ only. The primary endpoints were the recovery within 28 days, the need for mechanical ventilation, and death. The two groups were matched for age and gender. They had no significant difference regarding any of the baseline laboratory parameters or clinical severity grading. Clinical recovery after 28 days was achieved by 79.2% in the zinc group and 77.9% in zinc-free treatment group, without any significant difference (p = 0.969). The need for mechanical ventilation and the overall mortality rates did not show any significant difference between the 2 groups either (p = 0.537 and 0.986, respectively). The age of the patient and the need for mechanical ventilation were the only risk factors associated with the patients' mortality by the univariate regression analysis (p = 0.001 and < 0.001, respectively). Zinc supplements did not enhance the clinical efficacy of HCQ. More randomized studies are needed to evaluate the value of adding zinc to other therapies for COVID 19. ClinicalTrials.gov Identifier: NCT04447534

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Role of zinc in severe pneumonia: a randomized double bind placebo controlled study

Cited by 42 publications

References 11 publications

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

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

Zinc supplements for preventing otitis media

RETRACTED ARTICLE: Do Zinc Supplements Enhance the Clinical Efficacy of Hydroxychloroquine?: a Randomized, Multicenter Trial

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