Researchers at the Center for Public Health Kinetics in New Delhi, India, observed that a lower dose of zinc was well-tolerated for the treatment of diarrhea among children. These results, from a randomized, multicenter trial, were published in the New England Journal of Medicine.

Investigators recruited children (N=4500) in India and Tanzania who presented with acute diarrhea between 2017 and 2019 and randomly assigned them in a 1:1:1 ratio to receive 5, 10, or 20 mg of zinc daily for 14 days. They dissolved the zinc in 5 to 10 mL of water or breast milk and administered it to the children. The researchers monitored participants for symptoms of diarrhea, defined as ≥3 watery or loose stools per day.

The mean ages of children were 23 plus or minus 14.8, 22.7 plus or minus 14.6, and 23.2 plus or minus 15.3 months among the 5-, 10-, and 20-mg cohorts, respectively. The children were not dehydrated at recruitment, and they had an average of 5.7 loose, watery stools during the 24 hours before the start of the study.


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During the 30 minutes after administering the treatment, compared with the 20-mg group, the children in the 5- and 10-mg groups had a 29% and 19% lower risk of vomiting, respectively. The decreased rate of vomiting among the lower-dose groups was equivalent to a relative risk of 0.71 (97.5% CI, 0.59-0.86) among the low-dose and 0.81 (97.5% CI, 0.67-0.96) among the intermediate-dose cohorts.

Symptoms of diarrhea persisted for more than 5 days among 7.2% in the low-dose, 7.7% in the intermediate-dose, and 6.5% in the high-dose groups. Children in the 10-mg group had an average of 0.3 more stools (upper 98.75% CI, 1) and children in the 5-mg group had 0.1 more stools (upper 98.75% CI, 0.8) compared with children in the 20-mg group.

Researchers observed plasma levels of zinc increased after the first dose. Children in the 20-mg group had the highest plasma concentrations. Plasma zinc concentrations did not differ between groups after day 21.

Rates of diarrhea, fever, breathing difficulty, growth, and anthropometric status did not differ between study groups at the 30-, 45-, and 60-day follow-up assessments.

This study was limited by the fact that it relied on reporting from the caregivers of the children to record treatment compliance and outcomes.

These results indicated that treatment with low-dose supplemental zinc had similar amelioration of diarrheal symptoms and a lower risk of vomiting as the higher dose, making low-dose zinc a viable treatment option for acute diarrhea among children.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of authors’ disclosures.

Reference

Dhingra U, Kisenge R, Sudfeld CR, et al. Lower-dose zinc for childhood diarrhea — a randomized, multicenter trial. N Engl J Med. 2020;383(13):1231-1241.