Zinc Does Not Reduce Duration of Severe Pneumonia

Emma Hitt, PhD

March 05, 2012

March 5, 2012 — In hospitalized children with pneumonia, adjunct treatment with zinc showed only a limited benefit, according to the findings of a new randomized trial conducted in Nepal.

Sudha Basnet, MD, from the Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal, and colleagues report their findings in an article published online March 5 in Pediatrics.

According to the authors, zinc as adjuvant therapy for hospitalized children with pneumonia was beneficial in 1 clinical trial in Bangladesh, but other trials in India and Australia found no effect.

The current study, conducted in Nepal, sought to assess the efficacy of zinc as adjuvant therapy to standard antibiotic treatment in reducing the time to cessation and the risk for treatment failure for a severe pneumonia episode.

The study included 610 children aged 2 to 35 months who presented with severe pneumonia. Children received standard antibiotic treatment and were also randomly assigned to receive zinc (10 mg/day if younger than 12 months and 20 mg/day if older) or placebo daily for up to 14 days.

Although children receiving zinc recovered slightly more quickly than those not receiving zinc, the difference was not statistically significant (hazard ratio, 1.10; 95% confidence interval [CI], 0.94 - 1.30). The median time to cessation of severe pneumonia was identical (49 hours) in both groups, although the range of pneumonia duration was longer in patients receiving placebo.

Likewise, zinc was associated with a marginal but insignificant reduction in the risk for treatment failure (risk ratio, 0.88; 95% CI, 0.71 - 1.10).

More patients receiving the supplement vomited than did those receiving placebo (14% vs 9%; P = .052).

"This study enrolled 610 children and to our knowledge is the largest trial conducted to date on zinc given during severe pneumonia," Dr. Basnet and colleagues conclude.

According to the researchers, only 24% of patients had radiographically confirmed pneumonia, and there was significant beneficial effect of zinc in this subgroup, suggesting that further studies with more specific diagnoses may be needed. The authors did not discuss the prevalence of zinc deficiency in the study population.

The current findings are in contrast to those from another recent study conducted in Africa, and reported by Medscape Medical News, indicating that children aged 6 to 59 months with severe pneumonia had reduced mortality when receiving zinc in addition to standard antibiotics, especially in those infected with HIV.

The study was supported by the European Commission; the Meltzer Foundation in Bergen, Norway; the Danish Council of Developmental Research; and the Research Council of Norway. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online March 5, 2012. Full text

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