A randomized controlled trial of the effect of zinc as adjuvant therapy in children 2-35 mo of age with severe or nonsevere pneumonia in Bhaktapur, Nepal.
BACKGROUND
Pneumonia is a leading cause of illness and death in young children. Interventions to improve case management of pneumonia are needed.


OBJECTIVE
Our objective was to measure the effect of zinc supplementation in children with pneumonia in a population in which zinc deficiency is common.


METHODS
In a double-blind, placebo-controlled clinical trial, children aged 2-35 mo with severe (n = 149) or nonsevere (n = 2479) pneumonia defined according to criteria established by the World Health Organization were randomly assigned to receive zinc (10 mg for children aged 2-11 mo, 20 mg for children aged > or =12 mo) or placebo daily for 14 d as an adjuvant to antibiotics. The primary outcomes were treatment failure, defined as a need for change in antibiotics or hospitalization, and time to recovery from pneumonia.


RESULTS
One of 5 children did not respond adequately to antibiotic treatment; the odds ratios between zinc and placebo groups for treatment failure were 0.95 (95% CI: 0.78, 1.2) for nonsevere pneumonia and 0.97 (95% CI: 0.42, 2.2) for severe pneumonia. There was no difference in time to recovery between zinc and placebo groups for nonsevere (median: 2 d; hazard ratio: 1.0; 95% CI: 0.96, 1.1) or severe (median: 4 d; hazard ratio: 1.1; 95% CI: 0.79, 1.5) pneumonia. Regurgitation or vomiting < or =15 min after supplementation was observed more frequently among children in the zinc group than among those in the placebo group during the supplementation period (37% compared with 13%; odds ratio: 0.25; 95% CI: 0.20, 0.30).


CONCLUSIONS
Adjuvant treatment with zinc neither reduced the risk of treatment failure nor accelerated recovery in episodes of nonsevere or severe pneumonia. This trial was registered at clinicaltrials.gov as NCT00148733.
Valentiner-Branth
Palle
P
Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
Shrestha
Prakash S
PS
Chandyo
Ram K
RK
Mathisen
Maria
M
Basnet
Sudha
S
Bhandari
Nita
N
Adhikari
Ramesh K
RK
Sommerfelt
Halvor
H
Strand
Tor A
TA
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002097:C-Reactive Protein / Q000378:metabolism; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D008297:Male; D009390:Nepal; D010092:Oximetry; D011014:Pneumonia / Q000097:blood / Q000188:drug therapy*; D012119:Respiration; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*; D015032:Zinc / Q000008:administration & dosage* / Q000097:blood
D000900:Anti-Bacterial Agents; D006454:Hemoglobins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002097:C-Reactive Protein; D015032:Zinc