Oral Zinc as Adjuvant Therapy for Pediatric Recurrent Pneumonia: A Prospective Study in a Tertiary Care Hospital

Abstract

Zinc is an essential element required for the cell metabolism, including immunity. Therefore Zinc deficiency leads to susceptibility to infections and may affect pulmonary epithelial cell integrity. Many investigators have used zinc supplementation to see it’s effect on various diseases mainly diarrheal diseases and severe pneumonia. This study aims to evaluate the effect of oral Zinc supplementation in treatment and prevention of recurrent pneumonia. 506 Children aged 2 months to 60 months admitted during September 2011 to August 2014 for recurrent pneumonia with no other underlying illness in the Pediatric department of Manipal Teaching Hospital, Pokhara, Nepal were observed. Along with standard antibiotic treatment one group [Group I] received zinc (10 mg for < 6 months and 20 mg for ≥ 6 months for 10 days) and another group [Group II] did not receive Zinc. The primary outcome like resolution of tachypnea, chest in drawing, hypoxia, starting of oral feeds and hospital stay was noted. All cases were followed up every three monthly for one year to see the recurrence of pneumonia. Data was analyzed using SPSS version 16 and p < 0.01 was considered statistically significant. 20.24% of recurrent pneumonia meeting the inclusion criteria was evaluated. Maximum children (65.4%) were of age 2-12 months. Primary as well as secondary outcome was statistically significant (p<0.001) in Group I. The mean ± SD for primary outcome in Group I vs. Group II were –tachypnea (2.96±1.12 vs. 4.67 ± 1.61 days), chest in drawings (1.63 ±0.95 vs. 3.35 ±1.55 days), hypoxia (24.61 ±1.77 vs. 41.67 ± 2.11 hours), starting of oral feed (1.22 ±0.95 vs. 2.55 ± 1.23 days) and hospital stay (4.82 ±1.22 vs. 6.45 ± 1.99 days). In Group I 20/253 (7.9%) children lost follow up and 2/253(0.79%) patient died and in group II 1 (0.39%) died and 30 (11.85%) lost follow up. Recurrence of pneumonia was also significantly less (p<0.001) in zinc recipients. Determinants in two groups by logistic regression showed earlier resolution in zinc recipients with OR at 99% CI 9.654 (5.605, 16.625) for tachypnea, 14.506 (8.064, 26.095) for chest in drawings, 5.860 (3.415, 10.057) for hypoxia, 13.725 (7.270, 25.912) for starting oral feed and 0.075 (0.040, 0.140) for hospital stay. The recurrence of pneumonia was also less in group I with OR 3.348 at 99% CI (2.009, 5.581). Zinc as an adjuvant therapy is effective in treatment and prevention of recurrent pneumonia in children.