Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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. Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of causes of death in children. Lancet. 2005;365:1147–52.

    Article  PubMed  Google Scholar 

  3. Sazawal S, Black RE. Meta-analysis of intervention trials on case management of pneumonia in community settings. Lancet. 1992;340:528–33.

    Article  CAS  PubMed  Google Scholar 

  4. Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J ClinNutr. 1998;68:447S–63.

    CAS  Google Scholar 

  5. Bhatnagar S, Chandra U, Natchu M. Zinc in child health and disease. Indian J Pediatr. 2004;71:991–4.

    Article  PubMed  Google Scholar 

  6. 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.

    CAS  PubMed  Google Scholar 

  7. 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.

    CAS  PubMed  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Article  CAS  PubMed  Google Scholar 

  12. 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.

    Google Scholar 

  13. 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. 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  Google Scholar 

  15. 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.

    Article  CAS  Google Scholar 

  16. 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.

    CAS  Google Scholar 

  17. Bogden JD. Influence of zinc on immunity in the elderly. J Nutr Health Aging. 2004;8:48–54.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to Dr. Arvind Bansal, Department of Pharmaceutics, NIPER, Mohali for the preparation of placebo syrup. We also thank Mrs. Neetu Verma, Assistant Dispensary Superintendent, GMCH for coding of zinc and placebo syrups.

Contributions

The study was conceptualized by AB, SB and SJ. Subjects were enrolled by AB under supervision of VP and AS. Data was analysed by DC. Manuscript was written by AB and analysed critically by DC and SJ. JB was involved in analysis of pre and post—treatment zinc levels.

Conflict of Interest

None.

Role of Funding Source

None.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Government Medical College Hospital, Chandigarh, India

    Anuradha Bansal, Veena R. Parmar, Srikant Basu, Suksham Jain, Abhijeet Saha & Deepak Chawla

  2. Department of Biochemistry, Government Medical College Hospital, Chandigarh, India

    Jasbinder Kaur

Authors
  1. Anuradha Bansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Veena R. Parmar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Srikant Basu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jasbinder Kaur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Suksham Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abhijeet Saha
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Deepak Chawla
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deepak Chawla.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bansal, A., Parmar, V.R., Basu, S. et al. Zinc Supplementation in Severe Acute Lower Respiratory Tract Infection in Children: A Triple-Blind Randomized Placebo Controlled Trial. Indian J Pediatr 78, 33–37 (2011). https://doi.org/10.1007/s12098-010-0244-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-010-0244-5

Keywords

Search

Navigation