Oral zinc for treating diarrhoea in children

Lazzerini, Marzia; Ronfani, Luca

doi:10.1002/14651858.cd005436.pub2

Cited by 124 publications

(136 citation statements)

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“…Over the past 8 years, many more studies have been published and included in analyses and reviews that further our understanding of the roles of zinc supplementation [10,11,12,13,14]. The latest estimates report that zinc supplementation given to children aged >6 months of age with acute diarrhea reduces the duration of the episode on average by 12 h, and by 17 h for persistent diarrhea episodes [12,14], compared with placebo.…”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

“…The latest estimates report that zinc supplementation given to children aged >6 months of age with acute diarrhea reduces the duration of the episode on average by 12 h, and by 17 h for persistent diarrhea episodes [12,14], compared with placebo. Zinc supplements started at home also reduce hospital admissions and it is estimated that mortality due to diarrhea is reduced by 23% [15].…”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

“…The only two studies that specifically recruited children <6 months of age [16,17] failed to demonstrate efficacy and, currently, there is no evidence of a benefit of zinc supplements in this age group [4,13,14]. However, the issue is not closed because in some trials, there does seem to be benefit for younger infants.…”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

“…In Sachdev et al's [6] early studies, the benefits were seen in children with a low concentration of zinc in rectal mucosal biopsies, and in Brazil, low plasma zinc was associated with greater benefit [21]; nevertheless, meta-analyses have not confirmed that zinc status at baseline can predict outcome [13]. Zinc supplements were effective in trials in regions classified as high and medium risk of zinc deficiency but not in a trial in Poland where all the children were well nourished [21,22,14]. …”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

“…In fact, the reduction in duration is greater in persistent diarrhea [14]. Hospital studies tend to register greater impact of zinc, but there is no indication that this is attributable to the severity of the presenting diarrhea rather than to more accurate measurement [14]. …”

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

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Zinc Supplementation in Public Health

Penny

2013

Ann Nutr Metab

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Zinc is necessary for physiological processes including defense against infections. Zinc deficiency is responsible for 4% of global child morbidity and mortality. Zinc supplements given for 10-14 days together with low-osmolarity oral rehydration solution (Lo-ORS) are recommended for the treatment of childhood diarrhea. In children aged ≥6 months, daily zinc supplements reduce the duration of acute diarrhea episodes by 12 h and persistent diarrhea by 17 h. Zinc supplements could reduce diarrhea mortality in children aged 12-59 months by an estimated 23%; they are very safe but are associated with an increase in vomiting especially with the first dose. Heterogeneity between the results of trials is not understood but may be related to dose and the etiology of the diarrhea infection. Integration of zinc and Lo-ORS into national programs is underway but slowly, procurement problems are being overcome and the greatest challenge is changing health provider and caregiver attitudes to diarrhea management. Fewer trials have been conducted of zinc adjunct therapy in severe respiratory tract infections and there is as yet insufficient evidence to recommend addition of zinc to antibiotic therapy. Daily zinc supplements for all children >12 months of age in zinc deficient populations are estimated to reduce diarrhea incidence by 11-23%. The greatest impact is in reducing multiple episodes of diarrhea. The effect on duration of diarrheal episodes is less clear, but there may be up to 9% reduction. Zinc is also efficacious in reducing dysentery and persistent diarrhea. Zinc supplements may also prevent pneumonia by about 19%, but heterogeneity across studies has not yet been explained. When analyses are restricted to better quality studies using CHERG (Child Health Epidemiology Reference Group) methodology, zinc supplements are estimated to reduce diarrheal deaths by 13% and pneumonia deaths by 20%. National-level programs to combat childhood zinc deficiency should be accelerated.

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Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

Section: Zinc As Adjunct Therapy In the Treatment Of Diarrheal Diseasementioning

confidence: 99%

See 3 more Smart Citations

Zinc Supplementation in Public Health

Penny

2013

Ann Nutr Metab

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Oral zinc for treating diarrhoea in children

Lazzerini

Wanzira

2016

Cochrane Database of Systematic Reviews

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172

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Background In developing countries, diarrhoea causes around 500,000 child deaths annually. Zinc supplementation during acute diarrhoea is currently recommended by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Objectives To evaluate oral zinc supplementation for treating children with acute or persistent diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (the Cochrane Library 2016, Issue 5), MEDLINE, Embase, LILACS, CINAHL, m RCT, and reference lists up to 30 September 2016. We also contacted researchers. Selection criteria Randomized controlled trials (RCTs) that compared oral zinc supplementation with placebo in children aged one month to five years with acute or persistent diarrhoea, including dysentery. Data collection and analysis Both review authors assessed trial eligibility and risk of bias, extracted and analysed data, and drafted the review. The primary outcomes were diarrhoea duration and severity. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD) with 95% confidence intervals (CI). Where appropriate, we combined data in meta‐analyses (using either a fixed‐effect or random‐effects model) and assessed heterogeneity. We assessed the certainty of the evidence using the GRADE approach. Main results Thirty‐three trials that included 10,841 children met our inclusion criteria. Most included trials were conducted in Asian countries that were at high risk of zinc deficiency. Acute diarrhoea There is currently not enough evidence from well‐conducted RCTs to be able to say whether zinc supplementation during acute diarrhoea reduces death or number of children hospitalized ( very low certainty evidence ). In children older than six months of age, zinc supplementation may shorten the average duration of diarrhoea by around half a day (MD −11.46 hours, 95% CI −19.72 to −3.19; 2581 children, 9 trials, low certainty evidence ), and probably reduces the number of children whose diarrhoea persists until day seven (RR 0.73, 95% CI 0.61 to 0.88; 3865 children, 6 trials, moderate certainty evidence ). In children with signs of malnutrition the effect appears greater, reducing the duration of diarrhoea by around a day (MD −26.39 hours, 95% CI −36.54 to −16.23; 419 children, 5 trials, high certainty evidence ). Conversely, in children younger than six months of age, the available evidence suggests zinc supplementation may have no effect on the mean duration of diarrhoea (MD 5.23 hours, 95% CI −4.00 to 14.45; 1334 children, 2 trials, low certainty evidence ), or the num...

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