Treating young children with suspected serious bacterial infection with zinc in addition to standard antibiotics significantly reduces the likelihood of treatment failure, according to new research published Online First in The Lancet. In 2010, worldwide, infections were responsible for nearly two-thirds of deaths in children under 5, with around two-fifths of deaths occurring within the first month of life.
"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"*, explains Shinjini Bhatnagar from the Translational Health Science and Technology Institute and All India Institute of Medical Sciences in India, who led the research.
The researchers report the results of the first study to assess the efficacy of zinc given in addition to standard antibiotic therapy for suspected serious bacterial infections such as pneumonia, sepsis, and meningitis. Young children aged between 7 and 120 days who were being treated with antibiotics for serious infections in three hospitals in New Delhi, India, were randomly assigned to receive either 10 mg zinc (352 infants) or placebo (348) each day, given orally.
The results showed that children given zinc 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 those given placebo. There were 34 treatment failures in 332 children who received zinc, and 55 in 323 children given placebo (a relative risk reduction of 40%). Although not statistically significant, there was also a relative reduction (of 43%) in risk of death in the group assigned to zinc.
The authors say: "We would only need to give 15 children with probable serious bacterial infection zinc to prevent one treatment failure."*
They conclude: "Zinc syrup or dispersible tablets are already available in the public and private health-care systems for treatment of acute diarrhoea in many countries of low and middle income and the incremental costs to make this intervention available for young infants with probable serious bacterial infection would be small".
In a linked Comment, Christa Fischer Walker and Robert Black from John Hopkins Bloomberg School of Public Health, Baltimore, USA say: "This finding is important because case fatality is high in infants presenting with symptoms of probable serious bacterial infection".
They add: "The exact mechanism for the effect of supplemental zinc is unknown and needs further investigation, but the clinical benefits in diarrhoea and pneumonia in children younger than 5 years, and now in probable serious infections in young infants, suggest that therapeutic use of zinc could have wide application. Additionally, zinc could be beneficial…for other serious bacterial infections, such as those causing typhoid fever or meningitis".
Notes to Editors:
*Quotes direct from author and cannot be found in text of Article
Professor Shinjini Bhatnagar, Translational Health Science and Technology Institute, Haryana, India
T) + 91 124 2876 300 ext 551 / +91 989 9014 416 E) shinjini.bhatnagar@thsti.res.in
Professor Robert Black, John Hopkins Bloomberg School of Public Health, Baltimore, USA
T) +1 410 955 3934 E) rblack@jhsph.edu
Journal
The Lancet