The Efficacy of Zinc Supplementation on Outcome of Children with Severe Pneumonia. A Randomized Double-blind Placebo-controlled Clinical Trial

Valavi, Ehsan; Hakimzadeh, Mehran; Shamsizadeh, Ahmad; Aminzadeh, Majid; Alghasi, Arash

doi:10.1007/s12098-011-0458-1

Cited by 29 publications

(42 citation statements)

References 24 publications

(32 reference statements)

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“…This promising finding was consistently confirmed by three other RCT (10,11) . However, the study conducted by Wadhwa et al (11) demonstrated that only very severe pneumonia rather than all severe pneumonia could benefit from Zn.…”

Section: Introductionsupporting

confidence: 67%

“…In the remaining one, Zn was given at a dose of 2 mg/kg per d, with a maximum of 20 mg/d (10) . The supplementation duration was 5-14 d or until discharge from a hospital.…”

Section: Baseline Characteristics and Risk Of Biasmentioning

confidence: 99%

“…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 …”

mentioning

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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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: Introductionsupporting

confidence: 67%

“…In the remaining one, Zn was given at a dose of 2 mg/kg per d, with a maximum of 20 mg/d (10) . The supplementation duration was 5-14 d or until discharge from a hospital.…”

Section: Baseline Characteristics and Risk Of Biasmentioning

confidence: 99%

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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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“…34,35 It has been reported, for example, that zinc supplementation attenuates the symptoms of common cold, can accelerate recovery from pneumonia and other bacterial diseases and reduces diarrhea morbidity. 4,5,36 Besides, it is well known that during chemotherapy, a risk for such complications becomes higher, sometimes leading to treatment discontinuation. In adult patients receiving radiotherapy, oral zinc supplementation prevents opportunistic bacterial and fungal infections.…”

Section: Discussionmentioning

confidence: 99%

“…The beneficial effects of its supplementation in children in the management of infantile diarrhea, acute respiratory infections and pneumonia are evidenced by decreased morbidity and mortality. 4,5 Zinc supplementation manifests significant positive effects on linear growth, especially when administered alone, and hence it was strongly recommended in the National Health Service strategies in order to reduce stunting in children o5 years of age. 6 It was logical to believe that zinc might also be useful in patients undergoing chemotherapy for acute leukemia and its consecutive complications.…”

Section: Introductionmentioning

confidence: 99%

Zinc supplementation in children and adolescents with acute leukemia

et al. 2013

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LZZ Consolo, P Melnikov, FZ Cô nsolo, VA Nascimento and JCDV Pontes BACKGROUND/OBJECTIVES: Zinc is known as an essential micronutrient for human health because of its structural and biochemical functions, influencing growth and affecting multiple aspects of the immune system. Zinc has been extensively studied in neoplastic processes but its role in children with leukemia still remains to be elucidated in several aspects. The aim of this study was to evaluate the effects of oral zinc supplementation on weight gain and infectious episodes in children and adolescents with acute leukemia. SUBJECTS/METHODS: This study included 38 patients, and was carried out as a randomized, double-blind, placebo-controlled investigation. The dosage of plasma zinc levels and the evaluation of nutritional status were performed during a period of 60 days. Zinc was supplemented orally, 2 mg/kg/day, in the form of amino acid salt. RESULTS:The results showed that plasma zinc concentrations did not increase significantly with the addition of the micronutrient. However, from a clinical point of view, it has become evident that supplementary zinc exerts a positive effect on nutritional status as positive weight gain. Moreover, the number of infection episodes was significantly reduced, possibly because of the immune stimuli. CONCLUSIONS: In conclusion, zinc supplementation can prevent some of the chemotherapy adverse effects in children with leukemia, improving their quality of life.

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Host-imposed manganese starvation of invading pathogens: two routes to the same destination

2015

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During infection invading pathogens must acquire all essential nutrients, including first row transition metals, from the host. To combat invaders, the host exploits this fact and restricts the availability of these nutrients using a defense mechanism known as nutritional immunity. While iron sequestration is the most well-known aspect of this defense, recent work has revealed that the host restricts the availability of other essential elements, notably manganese, during infection. Furthermore, these studies have revealed that the host utilizes multiple strategies that extend beyond metal sequestration to prevent bacteria from obtaining these metals. This review will discuss the mechanisms by which bacteria attempt to obtain the essential first row transition metal ion manganese during infection, and the approaches utilized by the host to prevent this occurrence. In addition, this review will discuss the impact of host-imposed manganese starvation on invading bacteria.

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The Efficacy of Zinc Supplementation on Outcome of Children with Severe Pneumonia. A Randomized Double-blind Placebo-controlled Clinical Trial

Cited by 29 publications

References 24 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 supplementation in children and adolescents with acute leukemia

Host-imposed manganese starvation of invading pathogens: two routes to the same destination

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