Zinc Helpful in Children With Pneumonia - Medscape

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Zinc Helpful in Children With Pneumonia

Laurie Barclay, MD

May 21, 2004 ? Zinc supplements reduce the duration of illness and length

of hospital stay in children with pneumonia, according to the results of a

randomized trial published in the May 22 issue of The Lancet.

" The effects on treatment failure are striking, have significant

implications for reduction of antimicrobial resistance by decreasing

multiple antibiotic exposures, and could help reduce complications and

death in situations where second-line drugs are not available, " lead author

W. Abdullah , from the International Centre for Diarrhoeal Disease

Research in Dhaka, Bangladesh, says in a news release.

The rationale for this study is that zinc is reported to prevent pneumonia,

to prevent and treat diarrhea, and to enhance the immune response to

infection. In addition to standard hospital antibiotics, 270 children with

severe pneumonia (age range, two to 23 months) received 20 mg zinc daily or

placebo. Cessation of severe pneumonia was defined as no chest indrawing,

respiratory rate of 50 breaths per minute or less, and oxygen saturation at

least 95% on room air. Discharge from hospital was permitted when

respiratory rate was 40 breaths per minute or less for 24 consecutive hours

while patients were maintained only on oral antibiotics.

The group receiving zinc had reduced duration of severe pneumonia (relative

hazard [RH], .07; 95% confidence interval [CI], 0.51 - 0.98), including

duration of chest indrawing (RH, .80; 95% CI, 0.61 - 1.05), respiratory

rate more than 50 per minute (RH, .74; 95% CI, 0.57 - 0.98), and hypoxia

(RH, .79; 95% CI, 0.61 - 1.04).

Compared with the placebo group, patients in the zinc group recovered from

severe pneumonia one day earlier, and their average stay in the hospital

was one day shorter (RH for overall hospital duration, 0.75; 95% CI, 0.57 -

0.99). All effects were greater when children with wheezing were omitted

from analysis.

The zinc supplement was safe and well tolerated. Potential cost savings are

substantial, because a course of zinc treatment costs $0.15 in U.S.

dollars, and one day in the study hospital costs $25.

" This study needs to be replicated in other populations, including those

with and without a high prevalence of zinc deficiency and, as with zinc

studies of diarrhoeal disease, should include a follow-up period to look at

effects on subsequent illness, " the authors write. " Additionally, both

animal and human studies should also be undertaken to describe the precise

mechanism by which zinc interacts with the acute phase response, including

more detail on its effects on immunity. Such studies would allow the global

public-health significance of these findings to be assessed, and the

results best applied to improve child health and survival. "

Funding for this study came from the s Hopkins Family Health and Child

Survival ative Agreement with the U.S. Agency for International

Development, the U.S. Agency for International Development, core donors to

the International Centre for Diarrhoeal Disease Research, and the

Bangladesh Centre for Health and Population Research. The authors report no

potential financial conflicts of interest.

Lancet. 2004;363:1683-1688

Reviewed by D. Vogin, MD

Gan Ai Lynn

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