PURPOSE: A recent meta-analysis done on preventive role of zinc in childhood respiratory illness found significant reduction in the frequency and severity of respiratory illnesses. We conducted a systematic review on role of zinc as an adjunctive in treatment of acute lower respiratory tract illness (ALRTI) in children.
METHODS: A systematic search of published literature was done. Two reviewers independently applied eligibility criteria and assessed the studies for methodological quality using a standardized data extraction form. Randomized Controlled Trials (RCTs) (Quality score ≥ 3) using zinc as adjunctive in treatment of ALRTI were included. A pre-defined set of outcome measures were assessed. Weighted mean difference (WMD) with 95% confidence interval (CI) was calculated using RevMan (version 4.2.10).
RESULTS: After screening, 4 RCTs (India = 2, Bangladesh = 1, Australia = 1) spanning over 6 years including 909 subjects qualified for inclusion. There was no significant difference between the intervention and placebo group in the time of resolution of severe pneumonia [WMD 4.24 (95% CI -10.26, 18.74; p = 0.57)], as well as duration of hospitalization [WMD -5.07 (95% CI -12.34, 2.21; p = 0.17)]. No significant differences between two groups were noted for, duration of resolution of tachypnea [WMD 1.29 (95% CI -7.49, 10.06; p = 0.77)]; chest indrawing [WMD -3.52 (95% CI -11.59, 4.55; p = 0.39)] and hypoxia [WMD 0.43 (95% CI -8.99, 9.84; p = 0.93)]. However, the serum zinc level showed significant change, with higher level attended after treatment in the intervention group [WMD 2.57 (95% CI 2.1, 3.04; p < 0.00001)]. Side-effects (vomiting, bulging fontanelle) were not significant.
CONCLUSION: The evidence on use of zinc in treatment of ALRTI in children is limited.
CLINICAL IMPLICATIONS: Currently zinc can not be recommended as an adjunctive in treatment of ALRTI in children. Large multicentre RCTs in both developing and developed countries are needed before any firm conclusion can be made.
DISCLOSURE: Rashmi Das, No Financial Disclosure Information; No Product/Research Disclosure Information