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Adjunct therapy with zinc lowered treatment failure risk in children with serious bacterial infections
Young children with probable serious bacterial infection may benefit from zinc supplements, besides standard antibiotics, according to new study findings published this week.
Among infants aged 7 to 120 days, treatment with zinc resulted in significantly fewer treatment failures.
“Zinc is an accessible, low-cost intervention that could add to the effect of antibiotic treatment and lead to substantial reductions in infant mortality, particularly in developing countries where millions of children die from serious infections every year, and where second-line antibiotics and appropriate intensive care might not be available,” study researcher Shinjini Bhatnagar, PhD, of the Translational Health Science and Technology Institute and All India Institute of Medical Sciences in Gurgaon, India, said in a press release.
Young children who were being treated with antibiotics for probable serious infections in three hospitals in New Delhi, India, were randomly assigned to receive either 10 mg zinc (n=352) or placebo (n=348) given orally each day.
Significantly fewer treatment failures occurred in the zinc group (10%) compared with the placebo group (17%; RR reduction=40%; 95% CI, 10-60; absolute risk reduction=6.8%; 95% CI, 1.5-12). Treatment of 15 (95% CI, 8-67) infants with zinc would prevent one treatment failure. Ten infants receiving zinc died vs. 17 given placebo (RR=0.57; 95% CI, 0.27-1.23).
Infants in the zinc group were 40% less likely to experience treatment failure (measured as the need for secondary antibiotic treatment within 7 days, need for treatment in intensive care or death within 21 days) than infants who received placebo. There were 34 treatment failures in 332 children who received zinc, and 55 in 323 children given placebo (a RR reduction of 40%). Although not statistically significant, there was also a relative reduction (43%) in risk for death in the group assigned to zinc.
Time to recovery, weight gain or exclusive oral feeding was not affected by zinc supplements, and weight at recovery did not differ significantly among the two groups, according to the study results.
The investigators recommended additional studies to measure the effect of zinc supplementation on outcomes in children diagnosed with serious bacterial infections without measurements of concentrations of C-reactive protein.
“If such trials show improvement in treatment outcomes, the use of zinc as an adjunct to antibiotic treatment might lead to substantial reductions in infant mortality, particularly in resource-constrained settings where second-line antibiotics and appropriate intensive care might be unavailable,” the study researchers wrote.
Disclosure: Dr. Bhatnagar reports no relevant financial disclosures.
Perspective
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This paper details a well-performed randomized controlled trial of oral zinc in neonates and young infants presenting with suspected bacterial infections. The authors report that the addition of zinc to standard antibiotics led to several improvements in overall outcomes. This potentially is a very important finding.
Another recent Lancet paper reported that 7.6 million children died before their fifth birthday in 2010. Two-thirds of these deaths were caused by preventable infectious diseases, such as pneumonia, complications from diarrhea, malaria, and meningitis. (Liu L. Lancet. 2012, doi:10.1016/S0140-6736(12)60560-1). If findings from the zinc study could apply even more broadly, the potential impact could be vast. This is not an area without precedent: vitamin A was shown many years ago to improve morbidity and mortality in children with measles and is now recommended therapy by the World Health Organization. The addition of zinc to the list of inexpensive supplemental therapies is a significant expansion of our knowledge of the interplay between pathogen and host.
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Bhatnagar S. Lancet. 2012;doi:10.1016/S0140-6736(12)60477-2.