title: Zinc as an adjunct to the treatment of severe pneumonia in Ecuadorian children: a randomized controlled trial.
abstract: BACKGROUND
  Studies of zinc as an adjunct to treatment of severe pneumonia in children have shown mixed results, possibly because of poor information on zinc status and respiratory pathogens.
  
  
  OBJECTIVE
  We evaluated the effect of zinc given with standard antimicrobial treatment on the duration of respiratory signs in children with severe pneumonia. Zinc status and pathogens were assessed.
  
  
  METHODS
  Children aged 2-59 mo with severe pneumonia who were admitted to the main children's hospital in Quito, Ecuador, were given standard antibiotics and randomly allocated to receive zinc supplements twice daily or a placebo. Measurements included anthropometric variables, breastfeeding, hemoglobin, plasma zinc, and common bacteria/viral respiratory pathogens. The primary outcome was time to resolution of respiratory signs. The secondary outcome was treatment failure.
  
  
  RESULTS
  We enrolled 225 children in each group. There was no difference between groups in time to resolution of respiratory signs or treatment failure; pathogens were not associated with outcomes. Tachypnea and hypoxemia resolved faster in older children (P = 0.0001) than in younger ones. Higher basal zinc concentration (P = 0.011) and better height-for-age z score (HAZ) (P = 0.044) were associated with faster resolution of chest indrawing. Better weight-for-height z score (WHZ) (P = 0.031) and HAZ (P = 0.048) were associated with faster resolution of tachypnea. Increased C-reactive protein was associated with a longer duration of tachypnea (P = 0.044).
  
  
  CONCLUSIONS
  Zinc did not affect time to pneumonia resolution or treatment failure, nor did type of respiratory pathogens affect outcomes. Higher basal zinc and better HAZ and WHZ were associated with reduced time to resolution of respiratory signs. These results suggest the need for prevention of chronic zinc deficiency and improvement of general nutritional status among Ecuadorian children.
authors.affiliation: Corporación Ecuatoriana de Biotecnología, Quito, Ecuador (FS, BE, and OR); the Universidad Central del Ecuador, Escuela de Medicina, Quito, Ecuador (FS and BE); the Hospital de Niños Baca Ortiz, Quito, Ecuador (DG, MC, and GS); the Center for Global Health and Development, Boston University, Boston, MA (LLS and DHH); the Department of International Health, School of Public Health, Boston University, Boston, MA (LLS and DHH); the Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA (DHH); and the Gerald J and Dorothy R Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA (DHH).
authors.forename: Fernando
authors.initials: F
authors.lastname: Sempértegui
authors.forename: Bertha
authors.initials: B
authors.lastname: Estrella
authors.forename: Oswaldo
authors.initials: O
authors.lastname: Rodríguez
authors.forename: Dinor
authors.initials: D
authors.lastname: Gómez
authors.forename: Myryam
authors.initials: M
authors.lastname: Cabezas
authors.forename: Gilda
authors.initials: G
authors.lastname: Salgado
authors.forename: Lora L
authors.initials: LL
authors.lastname: Sabin
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use; D002657:Child Development; D002675:Child, Preschool; D003131:Combined Modality Therapy; D019587:Dietary Supplements; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D057194:Intention to Treat Analysis; D007902:Length of Stay; D059012:Lost to Follow-Up; D008297:Male; D009752:Nutritional Status; D010352:Patient Dropouts; D011014:Pneumonia / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy / Q000503:physiopathology; D012720:Severity of Illness Index; D059246:Tachypnea / Q000209:etiology / Q000517:prevention & control; D015032:Zinc / Q000097:blood / Q000172:deficiency / Q000627:therapeutic use*
chemical_list: D000890:Anti-Infective Agents; D015032:Zinc