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2022, Number 6

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Acta Pediatr Mex 2022; 43 (6)

Zinc sulfate as an adjunct to the treatment of children hospitalized for pneumonia. Randomized clinical trial

Kassisse-EL Hage EI, Rodríguez-Rodríguez Y, Mayo-Márquez N

Language: Spanish
References: 37
Page: 335-346
PDF size: 279.41 Kb.


ABSTRACT

Introduction: The results regarding the use of zinc in children hospitalized for pneumonia remain contradictory.
Objetive: To demonstrate the efficacy of zinc as an adjuvant.
Material and Method: Double blind randomized clinical trial in children under 5 years of age. Zinc sulfate or placebo was administered orally. The children received 10mg / day or 20mg / day of zinc according to their age administered for 14 days. Clinical and laboratory variables were recorded at admission, at 72 hours, and at day 7. The sample consisted in 100 patients per group The primary variable was the time necessary for the resolution of pneumonia and secondary variables, the time for the resolution of clinical indicators, therapeutic failure, and adverse effects. The variables were contrasted using the student’s t test or Mann-Whitney test and the test χ2. Statistical significance was considered with a value of p ‹0.05.
Results: The group that received zinc, showed a shorter time of resolution of pneumonia 72 vs 120 hours (p‹0.001) as well as the hours necessary to normalize each indicator clinical pneumonia (p‹0.001). Similarly, the hospital stay was shorter [(median 5 (4.8-5.2) vs 9 (8.3-9.7) (p‹0.001)] as well as the risk of therapeutic failure, the relative risk was 0.17 CI 95 (0,07- 0.38) p‹0,001. There were no significant differences in the appearance of adverse effects [relative risk 1.67 CI 95 (0.77-3.63)].
Conclusion: The addition of zinc to general therapy in children with pneumonia proved to be effective without relevant adverse events.


REFERENCES

  1. Smith KR, Samet JM, Romieu I, Bruce N. Indoor air pollutionin developing countries and acute lower respiratoryinfections in children. Thorax. 2000; 55(6):518-32

  2. Gerdien A. Tramper-Stranders. Community-acquired pneumonia:A review of etiology- and antimicrobial treatmentstudies. Paediatr Respir Rev. 2018; 26:41-48

  3. GBD 2016 Lower Respiratory Infections Collaborators.Estimates of the global, regional, and national morbidity,mortality, and aetiologies of lower respiratory infectionsin 195 countries, 1990-2016: a systematic analysis for theGlobal Burden of Disease Study 2016. Lancet Infect Dis.2018; 18:1191-1210.

  4. Rudan I, O'Brien KL, Nair H, Liu L, Theodoratou E, QaziS, Lukšić I, Fischer Walker CL, Black RE, Campbell H;Child Health Epidemiology Reference Group (CHERG).Epidemiology and etiology of childhood pneumonia in2010: estimates of incidence, severe morbidity, mortality,underlying risk factors and causative pathogens for 192countries J Glob Health. 2013; 3:010401.

  5. Araya S, Lovera D, Zarate C, Apodaca S, Acuña J, SanabriaG, Arbo A. Application of a prognostic scale to estimate themortality of children hospitalized with community-acquiredpneumonia. Pediatr Infect Dis. J 2016; 35:369–73

  6. Chisti MJ, Tebruegge M, La Vincente S, Graham SM, DukeT. Pneumonia in severely malnourished children in developingcountries—mortality risk, aetiology and validityof WHO clinical signs: a systematic review. Trop Med IntHealth. 2009; 14:1173–89.

  7. Caulfield LE, Richard SA, Black RE. Undernutrition as anunderlying cause of malaria morbidity and mortality inchildren less than five years old. Am J Trop Med Hyg. 2004;71:55-63.

  8. Krebs NF, Miller LV, Hambidge KM. Zinc deficiency in infantsand children: a review of its complex and synergisticinteractions Child Health. 2014; 34:279-88

  9. Black RE. Zinc Deficiency, Infectious Disease and Mortalityin the Developing World. J Nutr. 2003; 133:1485S-9S.

  10. Ibraheem, R. M., Johnson, A. B. R., Abdulkarim, A. A.,Biliaminu, S. A. Serum zinc levels in hospitalized childrenwith acute lower respiratory infections in the northcentralregion of Nigeria. African Health Sciences. 2014;14: 136-142.

  11. Shakur, M. S., Malek, M. A., Bano, N., Islam, K. Zinc Statusin Well Nourished Bangladeshi Children Suffering fromAcute Lower Respiratory Infection. Indian Pediatr. 2004;41:478-81.

  12. Maares M, Haase H. Zinc and immunity: An essentialinterrelation. Arch Biochem Biophys. 2016; 611:58-65.

  13. Solano L, Meertens L, Peña E, Argüello F. Deficiencia demicronutrientes. Situación actual. Ann Venez Nutr. 1998;11:48-54.

  14. Amaya D, Urrieta R, Gil N, Molano N, Medrano I, CastejónH. Valores de zinc plasmático en una población infantilmarginal de Maracaibo, Venezuela. Arch Latinoam Nutr.1997; 47:23-8. 28.

  15. Silva T, Alarcón O, Alarcón A O, Ramírez de Fernández M,D´Jesús I, Mejía A. Niveles séricos de Zinc (Zn), Hierro (Fe)y Cobre (Cu) de preescolares que acuden a consulta enlos ambulatorios urbanos tipo III de la ciudad de Mérida.MedULA. 2003(2005);12:18- 25.

  16. Rivera J, Sepúlveda J. Conclusions from the Mexican NationalNutrition Survey 1999: translating results into nutritionpolicy. Salud Pública Mex. 2003, 45: S565-S575.

  17. Lassi ZS, Moin A, Bhutta ZA. Zinc supplementation for theprevention of pneumonia in children aged 2 months to 59months. Cochrane Database of Systematic Reviews 2016,Issue 12. Art. No.:CD005978.

  18. Fataki MR, Kisenge RR, Sudfeld CR, Aboud S, Okuma J,Mehta S, et al. Effect of zinc supplementation on durationof hospitalization in Tanzanian children presenting withacute pneumonia. J Trop Pediatr. 2014; 60:104-11.

  19. Yuan X, Qian SY, Li Z, Zhang ZZ. Effect of zinc supplementationon infants with severe pneumonia. World J Pediatr.

  20. 2016; 12:166-9.20. Haider BA, Lassi ZS, Ahmed A, Bhutta ZA. Zinc supplementationas an adjunct to antibiotics in the treatment ofpneumonia in children 2 to 59 months of age. CochraneDatabase Syst Rev. 2011;( 10):CD007368

  21. Saleh P, Sadeghpour A, Mirza-Aghazadeh-Attari M, HatampourM, Naghavi-Behzad M, Tabrizi A. Relationshipbetween Plasma Levels of Zinc and Clinical Course of Pneumonia.Tanaffos. 2017; 16:40-45.

  22. Brooks WA, Yunus M, Santosham M, Wahed MA, NaharK, Yeasmin S, Black RE. Zinc for severe pneumonia in veryyoung children: double-blind placebo-controlled trial.Lancet. 2004; 363:1683-8.

  23. Scott JA, Wonodi C, Moïsi JC, Deloria-Knoll M, De-Luca AN, Karron RA, Bhat N, et al. PneumoniaMethods Working Group. The definition of pneumonia,the assessment of severity,and clinical standardizationinthe Pneumonia Etiology Research for ChildHealth study. Clin Infect Dis. 2012; 2: S109-16

  24. World Health Organization Multicenter Growth ReferenceStudy Group. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length,Weight-for-Height and Body Mass Index-for-Age: Methodsand Development. Geneva, Switzerland: World HealthOrganization; 2006

  25. Méndez C. Estudio nacional de crecimiento y desarrollohumano de la República de Venezuela. Proyecto Venezuela.Caracas 1996.

  26. Cherian, T., Mulholland, E. K., Carlin, J. B., Ostensen, H.,Amin, R., Campo, et al. Standardized interpretation of paediatricchest radiographs for the diagnosis of pneumoniain epidemiological studies. Bulletin of the World HealthOrganization, 2005;83: 353-359.,

  27. Qasemzadeh, M. J., Fathi, M., Tashvighi, M., Gharehbeglou,M., Yadollah-Damavandi, S., Parsa, Y., Rahimi, E The effectof adjuvant zinc therapy on recovery from pneumonia inhospitalized children: a double-blind randomized controlledtrial. Scientifica, 2014;2014:694193

  28. Shehzad N, Anwar MI, Muqaddas T. Zinc supplementationfor the treatment of severe pneumonia in hospitalizedchildren: a randomized controlled trial. Sudan J Paediatr2015; 15:37–41.

  29. Howie S, Bottomley C, Chimah O, Ideh R, Ebruke B, OkomoU, Onyeama C, Donkor S, Rodrigues O, et al. Zinc as anadjunct therapy in the management of severe pneumoniaamong Gambian children: randomized controlled trial. JGlob Health 2018; 8:010418.

  30. Rerksuppaphol L, Rerksuppaphol S. Efficacy of AdjunctiveZinc in Improving the Treatment Outcomes in HospitalizedChildren with Pneumonia: A Randomized Controlled Trial.Journal of Tropical Pediatrics, 2020; 66:419-427

  31. Sempértegui F, Estrella B, Rodríguez O, Gómez D, CabezasM, Salgado G, Sabin LL, Hamer DH. Zinc as an adjunct to thetreatment of severe pneumonia in Ecuadorian children: arandomized controlled trial. Am J Clin Nutr 2014; 99:497–505.

  32. Shah GS, Dutta AK, Shah D, Mishra OP. Role of zinc in severepneumonia: a randomized double bind placebo-controlledstudy. Ital J Pediatr. 2012; 38:36.

  33. Bose A, Coles CL, Gunavathi, John H, Moses P, Raghupathy P,Kirubakaran C, Black RE, Brooks WA, Santosham M. Efficacyof zinc in the treatment of severe pneumonia in hospitalizedchildren < 2 y old. Am J Clin Nutr 2006; 83:1089 –96.

  34. Basnet S, Prakash S., Sharma A, Mathisen M, Prasai R, BhandariN, Ramesh K, et al. Strand and members of the ZincSevere Pneumonia Study Group. A Randomized ControlledTrial of Zinc as Adjuvant Therapy for Severe Pneumonia inYoung Children. Pediatrics. 2012;129:701-8

  35. Acevedo-Murillo JA, García León ML, Firo-Reyes V, Santiago-Cordova JL, Gonzalez-Rodriguez AP, Wong-ChewRM. Zinc Supplementation Promotes a Th1 Response andImproves Clinical Symptoms in Fewer Hours in Childrenwith Pneumonia Younger Than 5 Years Old. A RandomizedControlled Clinical Trial. Front Pediatr. 2019 14; 7:431

  36. Wang L, Song Y. Efficacy of zinc given as an adjunct tothe treatment of severe pneumonia: A meta‐analysis ofrandomized, double‐blind, and placebo‐controlled trials.Clin Respir J. 2018; 12:857-64

  37. Rerksuppaphol S, Rerksuppaphol L. A randomized controlledtrial of zinc supplementation in the treatment ofacute respiratory tract infection in Thai children. PediatrRep. 2019; 11:7954.




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