Zinc and Pneumonia: Treatment and Prevention

Abstract

Presenter:Dr. Abdullah Brooks; Head of Infectious Disease Unit, ICDDR, B; Bangladesh

BackgroundPneumonia is a leading cause of morbidity and mortality in young children. Studies have shown that early reversal of severity signs: chest indrawing, hypoxia, and tachypnoea improve outcome. We hypothesized that zinc, an acute phase reactant, would shorten severe pneumonia and hospitalization duration.

MethodsIn a double-blind placebo controlled clinical trial in Matlab Hospital (ICDDR,B), in Bangladesh,  children 2-23 months old were randomized to receive 20 mg elemental zinc/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/min or less, oxygen saturation at least 95% on room air) and hospital discharge. Hospital discharge was allowed following respiratory rate of 40/minute or less for 24 consecutive hours while patients were maintained only on oral antibiotics.

Results270 children were enrolled between 23 August 1999 and 19 August 2001. The zinc group had reduced duration of severe pneumonia [relative hazard (RH) = 0.0.70 (95% CI:0. 51, 0.98)], including duration of chest indrawing [RH = 0.80 (95% CI: 0.61, 1.05)], respiratory rate (RR) > 50 [RH = 0.74 (95% CI: 0.57, 0.98)], and hypoxia [RH = 0.79 (95% CI: 0.61, 1.04)]; and overall hospital duration [RH = 0.75 (95%CI: 0.57, 0.99)]. The mean reduction is equivalent to one hospital day for both severe pneumonia and hospitalization. All effects were greater when children with wheezing were omitted from the analysis.

ConclusionAdjuvant therapy using 20 mg/day of zinc significantly reduces the duration of severe pneumonia and total hospitalization time.

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