Adding oral zinc to standard antibiotics reduced the risk of treatment failure by 40% compared with standard antibiotics alone in the treatment for serious infection in infants in developing countries, according to a new study.

Researchers at the Translational Health Science and Technology Institute (THSTI; Gurgaon, India), the University of Bergen (Norway), and other institutions conducted a randomized double-blind, placebo-controlled trial, that enrolled infants aged 7-120 days with probable serious bacterial infection at three hospitals in New Delhi (India), between July 6, 2005, and Dec 3, 2008. In all, 352 infants were assigned to receive 10 mg of zinc and 348 were assigned to receive placebo orally every day, in addition to standard antibiotic treatment. The primary outcome measure was treatment failure--defined as a need to change antibiotics within 7 days of randomization--or a need for intensive care, or death at any time within 21 days.

The results showed that significantly fewer treatment failures occurred in the zinc group (10%) than in the placebo group (17%), implying that treatment of 15 infants with zinc would prevent one treatment failure. In all, ten infants receiving zinc died, compared with 17 given placebo. Among the components, need for intensive care occurred in one zinc-treated infant and two in the placebo group. Change of antibiotics occurred equally often between groups for worsening of initial clinical features, but less often in the zinc group for persistence of initial clinical features. Recovery time did not improve with zinc. The study was published early online on May 21, 2012, in the Lancet.

“Infants with diarrhea appeared to particularly benefit, with a relative risk reduction of 69% compared with placebo. That benefit may have stemmed from replenishing zinc stores depleted by loss in stool,” concluded lead author Shinjini Bhatnagar, PhD, of the THSTI, and colleagues. “Zinc is important for mucosal barrier function and components of innate and adaptive immunity, such as lytic activity of phagocytes and natural killer cells, and expression of cytokines.”

Zinc is an essential trace element, necessary for plants, animals, and microorganisms. Zinc is found in nearly 100 specific enzymes, serves as structural ions in transcription factors, and is stored and transferred in metallothioneins. There are 2-4 grams of zinc distributed throughout the human body. Most zinc is in the brain, muscle, bones, kidney, and liver, with the highest concentrations in the prostate and parts of the eye. In humans, zinc interacts with a wide range of organic ligands, and has roles in the metabolism of RNA and DNA, signal transduction, and gene expression.

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