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Efficacy of zinc in the treatment of severe pneumonia in hospitalized children <2 y old^1,2,3

¹ From the Departments of Community Medicine (AB, G, and HJ) and Child Health (AB, PM, PR, and CK), Christian Medical College, Vellore, India; the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD (CLC, REB, WAB, and MS); and the Centre for Health and Population Research, International Centre for Diarrhoeal Disease, Research, Dhaka, Bangladesh (WAB)

Background:Severe pneumonia remains a leading cause of morbidity and mortality in undernourished young children in developing countries.

Objective:This study evaluated the effect of adjuvant zinc therapy on recovery from severe pneumonia by hospitalized children in southern India who were receiving standard antibiotic therapy.

Design:This randomized, double-blind, placebo-controlled clinical trial was conducted at the Christian Medical College Hospital, an 1800-bed teaching hospital in Tamilnadu, India. Enrollment and follow-up occurred between September 2003 and August 2004. Children aged 2–23 mo (n = 299) who were hospitalized with severe pneumonia were randomly assigned to receive 10-mg tablets of zinc sulfate or placebo twice a day during hospitalization, along with standard therapy for severe pneumonia. All clinical signs and symptoms of pneumonia were assessed and recorded at 8-h intervals.

Results:There were no clinical or statistically significant differences in the duration of tachypnea, hypoxia, chest indrawing, inability to feed, lethargy, severe illness, or hospitalization. Zinc supplementation was associated with a significantly longer duration of pneumonia in the hot season (P = 0.015).

Conclusions:Zinc supplementation had no overall effect on the duration of hospitalization or of clinical signs associated with severe infection in young children hospitalized for severe pneumonia in southern India. This finding differs from the results of 2 previously reported trials wherein zinc supplementation was associated with a shorter period of recovery from severe pneumonia. Given the conflicting results, further research in representative settings is required to help clarify the role of zinc in the treatment of severe pneumonia.

Key Words: Pneumonia • severe pneumonia • zinc • supplementation • treatment • adjuvant therapy • India

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