Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial.
BACKGROUND
Pneumonia is a leading cause of morbidity and mortality in young children. Early reversal of severity signs--chest indrawing, hypoxia, and tachypnoea--improves outcome. We postulated that zinc, an acute phase reactant, would shorten duration of severe pneumonia and time in hospital.


METHODS
In a double-blind placebo-controlled clinical trial in Matlab Hospital, Bangladesh, 270 children aged 2-23 months were randomised to receive elemental zinc (20 mg per day) or placebo, plus the hospital's standard antimicrobial management, until discharge. The outcomes were time to cessation of severe pneumonia (no chest indrawing, respiratory rate 50 per min or less, oxygen saturation at least 95% on room air) and discharge from hospital. Discharge was allowed when respiratory rate was 40 per minute or less for 24 consecutive hours while patients were maintained only on oral antibiotics.


RESULTS
The group receiving zinc had reduced duration of severe pneumonia (relative hazard [RH]=0.70, 95% CI 0.51-0.98), including duration of chest indrawing (0.80, 0.61-1.05), respiratory rate more than 50 per min (0.74, 0.57-0.98), and hypoxia (0.79, 0.61-1.04), and overall hospital duration (0.75, 0.57-0.99). The mean reduction is equivalent to 1 hospital day for both severe pneumonia and time in hospital. All effects were greater when children with wheezing were omitted from the analysis.


CONCLUSIONS
Adjuvant treatment with 20 mg zinc per day accelerates recovery from severe pneumonia in children, and could help reduce antimicrobial resistance by decreasing multiple antibiotic exposures, and lessen complications and deaths where second line drugs are unavailable.
Brooks
W Abdullah
WA
Centre for Health and Population Research, International Centre for Diarrhoeal Disease Research, Bangladesh, GPO Box 128 Mohakhali, Dhaka 1000, Bangladesh. abrooks@icddrb.org
Yunus
M
M
Santosham
Mathuram
M
Wahed
M A
MA
Nahar
Kamrun
K
Yeasmin
Sultana
S
Black
Robert E
RE
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010100:Oxygen / Q000097:blood; D018410:Pneumonia, Bacterial / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012119:Respiration; D015032:Zinc / Q000097:blood / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D015032:Zinc; D010100:Oxygen