Efficacy of zinc as an adjuvant therapy in acute pneumonia in children of age 2 months to 2 years: A randomized controlled trial
Authors: VIJAYA KUMAR  , CHETAN KERUR  , CHARAN KUMAR  , SRINIVASA S  , PILLARISETTY ACHALA  
Published: August 2024

Background: Pneumonia is the most common Illness affecting infants and children globally. Childhood pneumonia has been identified as the major “forgotten killer of children” by UNICEF and the WHO. The WHO and United Nations Children’s Fund (UNICEF) in 2013, published the integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) which outlined a framework for ending preventable child deaths due to diarrhoea and pneumonia by 2025. Zinc is a vital micro element that is essential for a variety of fundamental biological processes due to its function as a transition metal, cofactor, structural component, and signalling molecule. Zinc is also an essential component of antibacterial immunity. The impaired immunocompetence due to low zinc states enhances the establishment of a particular infection due to a reduction in the clearance of infectious agents. Recommend zinc nutritional intake is 10-20mg/day for children. It is estimated that 17-20% of the world’s population may be zinc deficient. Zinc deficiency is common among children in developing countries because of inadequate food intake, particularly from animal source and limited bioavailability from local diet. It has been proposed that zinc can be a real potential in the prevention of pneumonia morbidity and mortality. Objective: To study the effect of zinc supplementation as an adjuvant therapy on outcome of pneumonia. Method: We conducted a randomised controlled trial from march 2023 to february 2024. All children in the the age group of 2 months to 2 years, who presented with the features of pneumonia to the department of Paediatrics in Akash institute of medical sciences and research centre Devanhalli, Bangalore rural. Ethics consent was obtained from Institutional ethical committee. Demographic details such as name, age, gender along with clinical profile was taken. After admission, detailed history and physical and systemic examination were carried out and necessary data collected. Sample size being 50 cases, they were divided in two groups as case group (zinc group) and control group by stratified randomisation, 25 participants being in each group. Enrolled children were given standard treatment for pneumonia in the form of oxygen, intravenous fluids, bronchodilators, parenteral antibiotics. Enteral feeds were started once the child respiratory distress improved, oxygen saturations greater than 93%, baby was able to tolerate feed. Zinc group received 20 mg of elemental zinc per day as a single dose for 7 days. Result : Out of the total 50 cases, two groups were divided with 25 cases in zinc group and 25 cases in non-zinc group. In zinc group 6 cases (50%) took 24-48 hours for disappearance of symptoms, another 3 cases (26%) less than 24 hours, in 1 case time for disappearance of symptoms was 48-72 hours, another case which took 72-96 hours. The mean duration of time taken for disappearance of danger signs was 42.33 ± 13.89 hours. In the non-zinc group (36%) 5 cases took 24-48 hours for disappearance of danger signs, 3 cases (22%) which took 48-72 hours and 2 cases (14%) which took 96-120 hours, 2 more cases (14%) which took 120-144 hours. The mean duration of hospital stay in non-zinc group was 62.28 ± 10.84 hours which is comparatively more than that of zinc group. Conclusion: This study concluded that zinc supplementation shortens the time taken for resolution of respiratory distress and resolution of symptoms. However, it was not found to be of much help in improving oxygen saturation. It also did not show any significant decrease in time taken for disappearance of danger signs and duration of hospital stay.