ArticlesZinc for severe pneumonia in very young children: double-blind placebo-controlled trial
Introduction
Pneumonia is a leading cause of morbidity and mortality in children less than 5 years old. About 20% of deaths in such children are attributable to pneumonia (1·9 million deaths per year).1 Two-thirds of these deaths happen during infancy, and more than 90% are in developing countries.
Zinc is reported to prevent pneumonia,2, 3, 4, 5 and to prevent and treat diarrhoea.4, 6, 7, 8 It might act in the acute phase response to infection,9, 10 helping to boost the body's immune response through a defence cascade, beginning with mobilisation and sequestration of zinc to metallothionein-rich tissue, rapid upregulation of immune defence-specific protein synthesis, activation of immune defence activity such as macrophages, lymphocytes, and natural killer cells, and antibody-dependent cytotoxicity.11 Children with good zinc status may have a more robust immune response than those with poor zinc status.12, 13 Thus, our aim was to see whether zinc, along with antibiotics, would improve the outcome of severe pneumonia.
Section snippets
Methods
We undertook a double blind randomised placebo-controlled clinical trial in hospitalised children who were between 2 and 23 months old at the time of admission to the Matlab Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh Centre of Health and Population Research, a rural facility 50 km south of the capital Dhaka. Specifically, we investigated whether 20 mg zinc per day could shorten the duration of severe pneumonia and hospitalisation. We also measured the time to
Results
In total, 270 children were enrolled between Aug 23, 1999, and Aug 19, 2001. Of these, six (three from each group) left hospital against medical advice, and one (from the placebo group) withdrew from the study, but completed treatment in hospital (figure 1). Most (172 [64%]) patients were younger than 12 months, and most (177 [65%]) were male, which results from local health-seeking practices.
The mean duration of illness before hospitalisation was 2·5 days (SD 1·5), with no difference between
Discussion
We have shown clinically and statistically significant reductions in recovery time from severe pneumonia and overall hospital stay in children less than 2 years old given zinc with standard antimicrobial therapy. This improvement seems to result from substantial reductions in the resolution times of each of the severe pneumonia indicators, including chest indrawing, severely raised respiratory rate, and hypoxia, indicating a consistency between these specific signs and the diagnosis of severe
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