Zinc for acute diarrhea

Patel A. Zinc for acute diarrhea and Amoxicillin for pneumonia, do they work? Indian J Pediatr. 2015 Aug;82(8):703-6.

This presentation focuses on author’s research on the mechanisms by which zinc might contribute to the pathogenesis of acute diarrhea and the degree of success achieved in diarrhea control and treatment by zinc supplementation including its impact on mortality. However, emerging evidence in terms of controlled studies in humans beckons a more complete understanding of the mechanistic basis for zinc supplementation. Current evidence indicates that studies specifically addressing the variability in response to zinc supplementation need to be undertaken to better comprehend these mechanisms.

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Liberato SC, Singh G, Mulholland K. Zinc supplementation in young children: A
review of the literature focusing on diarrhoea prevention and treatment. Clin Nutr. 2015 Apr;34(2):181-8.

Prophylactic zinc has been shown to be effective in decreasing both prevalence and incidence of diarrhoea, reducing respiratory infections and improving growth in children with impaired nutritional status. There is less conclusive evidence of reduction in diarrhoea duration or diarrhoea severity. While prophylactic zinc decreases mortality due to diarrhoea and pneumonia, it has not been shown to affect overall mortality. Therapeutic use of zinc for the treatment of diarrhoea in children has been shown to reduce diarrhoea incidence, stool frequency and diarrhoea duration as well as respiratory infections in zinc deficient children. However, stool output is only reduced in children with cholera. Less conclusive evidence exists for therapeutic zinc reducing mortality due to diarrhoea and respiratory infections. Specific definitions of diarrhoea severity, respiratory infection in further studies as well as examination of prophylactic zinc effectiveness in diarrhoea duration and severity effectiveness of therapeutic zinc in reducing mortality due to diarrhoea and respiratory infections are warranted.

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Lazzerini M, Ronfani L. Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev. 2013 Jan 31;1:CD005436.

There is currently not enough evidence from well conducted randomized controlled trials to be able to say whether zinc supplementation during acute diarrhoea reduces death or hospitalization (very low quality evidence).

In children aged greater than six months with acute diarrhoea, zinc supplementation may shorten the duration of diarrhoea by around 10 hours (low quality evidence), and probably reduces the number of children whose diarrhoea persists until day seven (moderate quality evidence). In children with signs of moderate malnutrition the effect appears greater, reducing the duration of diarrhoea by around 27 hours (high quality evidence).

Conversely, in children aged less than six months, the available evidence suggests zinc supplementation may have no impact (low quality evidence), or even increase the proportion ofchildren whose diarrhoea persists until day seven (moderate quality evidence).

No trials reported serious adverse events, but zinc supplementation during acute diarrhoea causes vomiting in both age groups (high quality evidence).

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Patel A, et al. Therapeutic value of zinc supplementation in acute and persistent diarrhea: a systematic review. PLoS One. 2010 Apr 28;5(4):e10386.

The results of our systematic review suggest that zinc supplementation reduced the mean duration of acute diarrhea by approximately 20%, and persistent diarrhea by 15–30%, but had no significant effect on stool frequency or stool output. Further it was associated with a two- to three-fold higher risk of regurgitation in acute and persistent diarrhea, respectively. There was a high degree of statistically significant heterogeneity across the published studies for the effects of zinc supplementation on mean diarrheal duration and risk of vomiting following the administration of zinc.

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More PubMed results on zinc for acute diarrhea.

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