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Published in: Indian Journal of Pediatrics 1/2011

01-01-2011 | Original Article

Zinc Supplementation in Severe Acute Lower Respiratory Tract Infection in Children: A Triple-Blind Randomized Placebo Controlled Trial

Authors: Anuradha Bansal, Veena R. Parmar, Srikant Basu, Jasbinder Kaur, Suksham Jain, Abhijeet Saha, Deepak Chawla

Published in: Indian Journal of Pediatrics | Issue 1/2011

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Abstract

Objective

To evaluate the efficacy of zinc supplementation on duration of illness in children with severe acute lower respiratory tract infection (ALRTI).

Methods

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.

Results

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.

Conclusion

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.
Literature
1.
go back to reference 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. 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.
2.
go back to reference Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of causes of death in children. Lancet. 2005;365:1147–52.CrossRefPubMed Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of causes of death in children. Lancet. 2005;365:1147–52.CrossRefPubMed
3.
go back to reference Sazawal S, Black RE. Meta-analysis of intervention trials on case management of pneumonia in community settings. Lancet. 1992;340:528–33.CrossRefPubMed Sazawal S, Black RE. Meta-analysis of intervention trials on case management of pneumonia in community settings. Lancet. 1992;340:528–33.CrossRefPubMed
4.
go back to reference Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J ClinNutr. 1998;68:447S–63. Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J ClinNutr. 1998;68:447S–63.
5.
go back to reference Bhatnagar S, Chandra U, Natchu M. Zinc in child health and disease. Indian J Pediatr. 2004;71:991–4.CrossRefPubMed Bhatnagar S, Chandra U, Natchu M. Zinc in child health and disease. Indian J Pediatr. 2004;71:991–4.CrossRefPubMed
6.
go back to reference 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.PubMed 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.PubMed
7.
go back to reference 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.PubMed 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.PubMed
8.
go back to reference 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 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
9.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
10.
go back to reference 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 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
11.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
12.
go back to reference 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. 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.
13.
go back to reference 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. 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.
14.
go back to reference 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.PubMed 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.PubMed
15.
go back to reference 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, 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
16.
go back to reference 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. 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.
17.
go back to reference Bogden JD. Influence of zinc on immunity in the elderly. J Nutr Health Aging. 2004;8:48–54.PubMed Bogden JD. Influence of zinc on immunity in the elderly. J Nutr Health Aging. 2004;8:48–54.PubMed
Metadata
Title
Zinc Supplementation in Severe Acute Lower Respiratory Tract Infection in Children: A Triple-Blind Randomized Placebo Controlled Trial
Authors
Anuradha Bansal
Veena R. Parmar
Srikant Basu
Jasbinder Kaur
Suksham Jain
Abhijeet Saha
Deepak Chawla
Publication date
01-01-2011
Publisher
Springer-Verlag
Published in
Indian Journal of Pediatrics / Issue 1/2011
Print ISSN: 0019-5456
Electronic ISSN: 0973-7693
DOI
https://doi.org/10.1007/s12098-010-0244-5

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