Zinc plus antibiotics saves lives of children with pneumonia, study finds

Zinc used in conjunction with antibiotics significantly reduced mortality in children aged 6 months to 59 months with severe pneumonia when compared with antibiotics alone, according to the findings of a recent study done in Uganda.

The study, published online February 8 in BMC Medicine, also indicated that the adjunct therapy had a greater effect among HIV-infected children than those who were not infected with HIV.

The double-blind, randomized, placebo-controlled study was led by Maheswari G. Srinivasan, from the Department of Pediatrics and Child Health at the School of Medicine, in Uganda. Researchers enrolled 352 children, aged 6 months to 59 months, who were admitted to the Mulago Hospital pediatric emergency ward with severe pneumonia between September 2006 and March 2007.

"There are 2 key findings in this study: overall, zinc supplementation in these children significantly decreased case fatality, but did not reduce the time to normalization of the parameters for disease severity," the authors stated, noting that these findings come from the secondary objective rather than the primary objectives, which were to assess the effect of zinc as an adjunct therapy on time to normalization of respiratory rate, temperature, and oxygen saturation.

The investigators randomly assigned the children to receive standard antibiotic therapy plus zinc (10 mg for children aged under 12 months; 20 mg for children 12 months and older) or standard antibiotic therapy plus placebo daily. The children were assessed every 6 hours for the first 48 hours and then every 12 hours for 7 days of treatment.

The investigators found no evidence that zinc decreased length of time to recovery. They did, however, note the number of deaths was lower among the children who were treated with zinc (4.0% vs 11.9%; RR=0.33; 95% CI, 0.15-0.76).

In addition, the researchers noted that the effect of zinc supplementation appeared stronger among children infected with HIV. There were more deaths among HIV-positive children assigned to placebo compared with those who received zinc (25.9% vs 0%; RR=0.1; 95% CI, 0.0-1.0).

Among those children who were not infected with HIV and who received placebo, the death rate was 5.5% versus 3.9% among HIV-uninfected children who received zinc (RR=0.7; 95% CI, 0.2-2.2).

“Acute respiratory tract infections are the most common cause of morbidity and deaths in children less than 5 years,” the authors wrote in their background. “Given these results,” the authors stated, “zinc could be considered for use as adjunct therapy for severe pneumonia, especially among Highly Active Antiretroviral Therapy-naïve, HIV-infected children in our environment.”