EFFECTIVENESS OF ZINC AS AN ADJUNCT TO ANTIBIOTICS IN THE MANAGEMENT OF SEVERE CHILDHOOD PNEUMONIA: A PROSPECTIVE COMPARATIVE STUDY
DOI:
https://doi.org/10.69723/njms.04.04.0645Keywords:
Zinc,, Pneumonia, Pediatrics, Antibiotics,, Adjunctive Therapy,Abstract
Abstract
Background:
Pneumonia remains a leading cause of morbidity and mortality in children under five, particularly in low-resource settings. Zinc, an essential micronutrient with immunomodulatory properties, may enhance recovery when used alongside standard antibiotic therapy. However, evidence regarding its therapeutic efficacy remains inconclusive.
Objective:
To assess the effectiveness of adjunctive zinc supplementation in reducing symptom resolution time and improving treatment outcomes in children aged 6–59 months with severe pneumonia.
Methodology:
This prospective comparative observational study was conducted at the Federal Government Polyclinic Hospital, Islamabad, over seven months. A total of 160 children diagnosed with WHO-defined severe pneumonia were divided into two groups: Group I received standard antibiotics plus oral zinc (2 mg/kg twice daily for 7 days), and Group II received antibiotics alone. Clinical parameters were monitored, and the primary outcome was time to symptom resolution. Secondary outcomes included treatment success rate and duration of hospital stay.
Results:
Children in Group I showed significantly faster symptom resolution (23.3 ± 10.1 hours vs. 43.2 ± 10.1 hours; p < 0.001) and higher treatment success (93.8% vs. 68.8%). Subgroup analysis by gender, age, nutritional status, and vaccination history consistently favored the zinc group (p < 0.001).
Conclusion:
Adjunctive zinc supplementation significantly enhances recovery and treatment success in children with severe pneumonia. Its use may reduce healthcare burden in resource-limited settings. Further large-scale randomized controlled trials are recommended to validate these findings and explore pathogen-specific responses.
References
1. Hashemian H, Alizadeh H, Kazemnejad-Leyli E. Efficacy of zinc as adjuvant therapy in the treatment of severe pneumonia in hospitalized children: a randomized clinical trial. Arch Pediatr Infect Dis. 2020;9(1):e105318. https://doi:10.5812/pedinfect.105318.
2. Milani GP, Alberti I, Abodi M, Lakoumentas J, Konstantinou GN, Papadopoulos NG, et al. A systematic review and meta-analysis on nutritional and dietary interventions for the treatment of acute respiratory infection in pediatric patients: an EAACI taskforce. Allergy. 2024. Epub 2024 Jan 4. https://doi:10.1111/all.15997.
3. Relan P, Garbern SC, O’Reilly G, Bills CB, Schultz M, Kivlehan S, et al. Emergency care interventions for paediatric severe acute respiratory infections in low- and middle-income countries: a systematic review and narrative synthesis. J Glob Health. 2023;13:04065. https://doi:10.7189/jogh.13.04065.
4. Kazi T, Hussain SA, Hussain Z, Shehzad MA, Gulfam S, Khan S. Comparison of zinc supplementation versus placebo in addition to standard therapy for management of children with pneumonia. J Postgrad Med Inst. 2024;38(3). [cited 2025 Dec 3]. :https://doi.org/10.54079/jpmi.38.3.3348
5. Hooli S, King C, McCollum ED, Colbourn T, Lufesi N, Mwansambo C, et al. In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: a secondary analysis of the PREPARE dataset. Int J Infect Dis. 2023;129:240–50. https://doi.org/10.1016/j.ijid.2023.02.005
6. Kassisse-EL Hage EI, Rodríguez-Rodríguez Y, Mayo-Márquez N. Zinc sulfate as an adjunct to the treatment of children hospitalized for pneumonia. Randomized clinical trial. Acta Pediatr Mex. 2022;43(6):335-346. available from: https://www.medigraphic.com/pdfs/actpedmex/apm-2022/apm226c.pdf
7. Pecora F, Persico F, Argentiero A, Neglia C, Esposito S. The role of micronutrients in support of the immune response against viral infections. Nutrients. 2020;12(10):3198. Available from: https://doi.org/10.3390/nu12103198
8. Rerksuppaphol L, Rerksuppaphol S. Efficacy of adjunctive zinc in improving the treatment outcomes in hospitalized children with pneumonia: a randomized controlled trial. J Trop Pediatr. 2020;66(4):419–27.https://doi.org/10.1093/tropej/fmz082
9. Rouhani, P., Rezaei Kelishadi, M. & Saneei, P. Effect of zinc supplementation on mortality in under 5-year children: a systematic review and meta-analysis of randomized clinical trials. Eur J Nutr 61, 37–54 (2022). https://doi.org/10.1007/s00394-021-02604-1
10. Muddasani DV, Thirumurugesan DS, Dhanasangari D, Panchatcharam DL. Efficacy of adjuvant zinc supplementation in severe pneumonia among children aged 2–60 months: a double-blind randomized controlled trial. TPM Test Psychometrics Methodol Appl Psychol. 2025;32(S3):1608–15. available from: https://tpmap.org/submission/index.php/tpm/article/view/874
11.Yasin U, Sheikh SU, Hamid S. Effect of zinc in severe pneumonia in children aged 6 months to 5 years in Allied Hospital, Faisalabad. Prof Med J. 2019;26(9):1409–12. https://doi.org/10.29309/TPMJ/2019.26.09.781
12. Padmini SK, Mahesh K, Durgappa H, Sathiyamoorthi S. Zinc as an adjuvant therapy in acute severe pneumonia in children aged two months to two years: a double-blind randomized controlled trial. Cureus. 2025;17(4):e https://doi.org/10.7759/cureus.82402
13. Ahadi A, Mirzarahimi M, Barak M, Ahari SS, Reyhanian M. Comparing the effect of zinc gluconate and placebo in the treatment of tachypnea, dyspnea and fever in children aged 2 to 23 months with acute bronchiolitis. Int J Clin Trials. 2020;7(2):50–4. https://doi.org/10.18203/2349-3259.ijct20201711
14. Ashraf F, Babar H, Ahmed S, Shahwani N, Rabnawaz K, Anis M. Impact of zinc supplementation on duration of hospitalization in children with pneumonia. Biol Clin Sci Res J. 2024;2024(1):1263.. https://doi.org/10.54112/bcsrj.v2024i1.1263
15. Saied A, El Borolossy RM, Ramzy MA, Sabri NA. Effect of zinc versus vitamin A supplementation on pediatric patients with community-acquired pneumonia. Front Pharmacol. 2022;13:933998. https://doi.org/10.3389/fphar.2022.933998
16. Brown N, Kukka AJ, Mårtensson A. Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Paediatr Open. 2020;4:e000662. https://doi.org/10.1136/bmjpo-2020-000662.
17. Danish M, Shi C-S, Yang Z-W, Cheng D-L, Xing Y, Wu F-F. Importance of zinc supplementation in the treatment of pneumonia. Ann Int Med Dent Res (Online). 2020;6(5):PE4. https://doi.org/10.21276/aimdr.2020.6.5.PE4
18. Naz L, Ghimire U. Assessing the prevalence trend of childhood pneumonia associated with indoor air pollution in Pakistan. Environ Sci Pollut Res Int. 2020;27:44540–51. https://doi.org/10.1007/s11356-020-10346-6
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Sidra Nisar, Aisha Khalid Asadullah Khan, Shiza Rizwan Qazi, Shahzad Munir, Naveed Ashraf
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Readers may “Share-copy and redistribute the material in any medium or format” and “Adapt-remix, transform, and build upon the material”. The readers must give appropriate credit to the source of the material and indicate if changes were made to the material. Readers may not use the material for commercial purposes. The readers may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
.png)
