Oral zinc for the treatment of acute gastroenteritis in Polish children: a randomized, double-blind, placebo-controlled trial. Randomized, community-based trial of the effect of zinc supplementation, with and without other micronutrients, on the duration of persistent childhood diarrhea in Lima, Peru. Operational Issues and Trends Associated with the Pilot Introduction of Zinc for Childhood Diarrhoea in Bougouni District, Mali Substantial reduction in severe diarrheal morbidity by daily zinc supplementation in young north Indian children. Zinc Supplementation in Malnourished Children With Persistent Diarrhea in Pakistan Influence of Zinc Supplementation in Acute Diarrhea Differs by the Isolated Organism Zinc supplementation in Brazilian children with acute diarrhoea Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Home management of childhood diarrhoea in southern Mali--implications for the introduction of zinc treatment. [Anti-infection prophylaxis in cardiac surgery: comparison of single-dose ceftriaxone and cefamandole in repeat doses]. A Pilot Test of the Addition of Zinc to the Current Case Management Package of Diarrhea in a Primary Healthcare Setting Zinc Therapy for Diarrhoea Improves Growth Among Bangladeshi Infants 6 to 11 Months of Age Operational Feasibility of Implementing Community-Based Zinc Supplementation: Impact on Childhood Diarrheal Morbidity Efficacy of zinc supplementation on the severity and duration of diarrhea in malnourished Turkish children. Zinc Supplementation in Acute Diarrhea is Acceptable, Does Not Interfere with Oral Rehydration, and Reduces the Use of Other Medications: A Randomized Trial in Five Countries Efficacy of zinc-fortified oral rehydration solution in 6- to 35-month-old children with acute diarrhea. Demonstration of the effectiveness of zinc in diarrhoea of children living in Switzerland
OBJECTIVE To evaluate the efficacy and safety of zinc in the treatment of acute gastroenteritis ( AGE ) in children in Pol and . STUDY DESIGN Children aged 3 to 48 months with AGE were enrolled in a r and omized , double-blind , placebo-controlled trial in which they received zinc sulfate ( 10 or 20 mg/day depending on age ) or placebo for 10 days . A total of 141 of 160 children recruited were available for intention-to-treat analysis . The primary outcome was the duration of diarrhea . RESULTS In the experimental group ( n = 69 ) compared with the control group ( n = 72 ) , there was no significant difference in the duration of diarrhea ( P > .05 ) . Similarly , there was no significant difference in the groups in secondary outcome measures such as stool frequency on days 1 , 2 , and 3 , vomiting frequency , intravenous fluid intake , and the number of children with diarrhea lasting > 7 days . CONCLUSION Children living in a country where zinc deficiency is rare do not appear to benefit from the use of zinc in the treatment of AGE OBJECTIVE To determine whether supplemental zinc , with or without additional micronutrients , affects the severity and duration of persistent childhood diarrhea  and the rate of nutritional recovery . DESIGN The study was a community-based , double-blind , r and omized trial implemented in a shanty town in Lima , Peru . Children aged 6 to 36 months with persistent ( > /=14 days ) diarrhea received daily , for 2 weeks , a placebo ( group P , n = 136 ) or a supplement of 20 mg of zinc , either with ( group Z+VM , n = 137 ) or without ( group Z , n = 139 ) additional vitamins and minerals . Symptoms of illness were recorded daily , and biochemical and anthropometric assessment s were completed at baseline and on day 15 . RESULTS The treatment groups were similar at baseline with regard to the characteristics of the presenting episode , anthropometric data , and plasma zinc concentration . The children consumed , on average , 95 % ( group P ) , 94 % ( group Z ) , or 88 % ( group Z+VM ) of the supplement ( P < .001 ) . The plasma zinc concentration did not change significantly from baseline to day 15 in group P ( 4 microg/dL ) but increased by 38 microg/dL in group Z and 14 microg/dL in group Z+VM . The median duration of diarrhea after starting treatment was 1 day ; among children who continued to have diarrhea , there was a significant effect of treatment on diarrheal duration ( P = .04 , analysis of covariance ) . Specifically , the duration of illness was significantly reduced by 28 % in children in group Z ( P = .01 ) and by 33 % in girls in group Z+VM ( P = .04 ) . There were no differences in the severity of the episode by treatment group . CONCLUSION There was a significant reduction in the duration of persistent diarrhea in selected subgroups of zinc-supplemented ambulatory patients in this population Zinc for the treatment of childhood diarrhoea was introduced in a pilot area in southern Mali to prepare for a cluster-r and omized effectiveness study and to inform policies on how to best introduce and promote zinc at the community level . Dispersible zinc tablets in 14-tablet blister packs were provided through community health centres and drug kits managed by community health workers ( CHWs ) in two health zones in Bougouni district , Mali . Village meetings and individual counselling provided by CHWs and head nurses at health centres were the principal channels of communication . A combination of methods were employed to ( a ) detect problems in communication about the benefits of zinc and its mode of administration ; ( b ) identify and resolve obstacles to implementation of zinc through existing health services ; and ( c ) describe household-level constraints to the adoption of appropriate home-management practice s for diarrhoea , including administration of both zinc and oral rehydration solution ( ORS ) . Population -based household surveys with caretakers of children sick in the previous two weeks were carried out before and four months after the introduction of zinc supplementation . Household follow-up visits with children receiving zinc from the health centres and CHWs were conducted on day 3 and 14 after treatment for a sub sample of children . A qualitative process evaluation also was conducted to investigate operational issues . Preliminary evidence from this study suggests that the introduction of zinc does not reduce the use of ORS and may reduce inappropriate antibiotic use for childhood diarrhoea . Financial access to treatments , management of concurrent diarrhoea and fever , and high use of unauthorized drug vendors were identified as factors affecting the effectiveness of the intervention in this setting . The introduction of zinc , if not appropriately integrated with other disease-control strategies , has the potential to decrease the appropriate presumptive treatment of childhood malaria in children with diarrhoea and fever in malaria-endemic areas OBJECTIVE To evaluate the impact of 4 months of daily zinc supplementation on the incidence of  severe and recurrent diarrhea in children 6 to 30 months of age . METHODS A double-blind , r and omized , placebo-controlled trial was conducted on children who were identified by a door-to-door survey to be aged 6 to 30 months and residing in the urban slum of Dakshinpuri , New Delhi . They were r and omized to receive daily zinc gluconate ( elemental zinc 10 mg to infants and 20 mg to older children  ) or placebo . A field attendant administered the syrup daily at home for 4 months except on Sundays , when the mother did so . One bottle that contained 250 mL was kept in the child 's home and replaced monthly . Field workers visited households every seventh day during the 4-month follow-up period . At each visit , information was obtained for the previous 7 days on history of fever , number and consistency of stools , and presence of cough . When the child was ill , illness characteristics and treatment seeking outside the home were determined . If the child had diarrhea or vomiting , then dehydration was assessed . At household visits , 2 packets of oral rehydration salts were given when a child had diarrhea . Children who visited the study clinic spontaneously for illness or were referred by the field workers were treated according to the st and ard national program guidelines . Antibiotics were advised only for diarrhea with bloody stools or for associated illnesses . For using generalized estimating equations for longitudinal analysis of a recurring event such as diarrhea , the follow-up data for each child was divided into 17 child-periods of 7 days each and presence or absence of an incident episode of diarrhea or severe diarrhea within each 7-day period was coded . This method of analysis does not assume independence of events and therefore prevents underestimation of variance that results because of correlation of morbidity within the same child . A logistic generalized estimating equations model with exchangeable correlation covariance-variance matrix was then used to estimate the effect size . RESULTS Zinc or placebo doses were administered on 88.8 % and 91.2 % , respectively , of study days during the 4 months of follow-up . There was a small but significant increase in the average number of days with vomiting in the zinc group ( 4.3 [ st and ard deviation ( SD ) : 5.8 ] vs 2.6 [ SD 3.9 ] days ; difference in means : 1.7 [ 95 % confidence interval ( CI ) : 1.3 - 2.1 ] days ) . At the baseline , mean plasma zinc was 62.0 microg/dL ( SD : 14.3 microg/dL ) in the zinc and 62.0 microg/dL ( SD : 11.2 microg/dL ) in the placebo group ; 45.8 % and 42 % , respectively , had low plasma zinc levels below 60 microg/dL. At the end of the study , plasma zinc levels were substantially higher in the zinc group ( ratio of geometric means : 1.94 [ 95 % CI : 1.86 - 2.03 ] ) and the proportion with low plasma zinc was lower ( difference in proportions : -46.7 % [ 95 % CI : -41.8 % to -51.4 % ] ) . The incidence of diarrhea during follow-up was lower in the zinc-supplemented as compared with the placebo group ( odds ratio [ OR ] : 0.88 ; 95 % CI : 0.82 - 0.95 ) . The beneficial impact of zinc was greater on the incidence of diarrhea with progressively increasing duration : episodes of diarrhea that lasted 1 to 6 days ( OR : 0.92 ; 95 % CI : 0.85 - 1.00 ) , 7 to 13 days ( OR : 0.79 ; 95 % CI : 0.65 - 0.95 ) , and > or = 14 days ( OR : 0.69 ; 95 % CI : 0.48 - 0.98 ) . The impact was also greater on the incidence of episodes with progressively higher stool frequency : 3 to 5 stools per day ( OR : 0.90 ; 95 % CI : 0.83 - 0.98 ) , 6 to 9 stools per day ( OR : 0.87 ; 95 % CI : 0.77 - 0.98 ) , and > or = 10 per day ( OR : 0.77 ; 95 % CI : 0.63 - 0.94 ) . In the zinc group , significantly more children experienced no diarrheal episode during the study period ( risk ratio [ RR ] : 1.22 ; 95 % CI : 1.02 - 1.44 ) . Furthermore , substantially fewer children ( RR : 0.51 ; 95 % CI : 0.36 - 0.73 ) experienced recurrent diarrhea , defined as > 6 diarrheal episodes in the follow-up period as compared with children in the placebo group . The number of children who were hospitalized for any cause tended to be lower in the zinc group , but the difference was not statistically significant ( 1.79 % vs 2.43 % ; RR : 0.74 ; 95 % CI : 0.43 - 1.27 ) . The baseline mean plasma copper ( microg/dL ) was similar in the 2 groups ( difference in means : 1.6 ; 95 % CI : -2.9 to 6.1 ) . The end study plasma copper levels were significantly lower in the zinc group ( difference in means : -15.5 ; 95 % CI : -19.9 to - 11.1 ) . CONCLUSIONS Zinc supplementation substantially reduced the incidence of severe and prolonged diarrhea , the 2 important determinants of diarrhea-related mortality and malnutrition . This intervention also substantially reduced the proportion of children who experienced recurrent diarrhea . Prompt measures to improve zinc status of deficient population s are warranted . The potential approaches to achieve this goal include food fortification , dietary diversification , cultivation of plants that are zinc dense or have a decreased concentration of zinc absorption inhibitors , and supplementation of selected groups of children . Future studies should assess the impact of increased zinc intakes on childhood  mortality in developing countries . For facilitating intervention , there is a need to obtain reliable estimates of zinc deficiency , particularly in developing countries . The functional consequences of the effect of various doses of zinc on plasma copper levels merits additional study Objective . To evaluate the potential benefit of dietary supplementation of a rice-lentil ( Khitchri ) and yogurt diet with 3 mg/kg/d of elemental zinc ( as zinc sulfate ) in hospitalized malnourished children ( age 6–36 months ) with persistent diarrhea for 14 days . Methodology . R and omized , double-blind placebo-controlled trial . Setting . Nutrition Research Ward at the National Institute of Child Health , Karachi , Pakistan , where children were admitted for 14 days of inpatient supervised rehabilitation . Main Outcome Measures . Primary outcome : overall weight gain by day 14 . Secondary outcomes : overall energy intake , stool output , time to diarrheal recovery and weight gain ( ≥3 days ) , plasma zinc , copper , prealbumin , and insulin-like growth factor-1 . Results . Of 87 children r and omized for supplementation with either zinc or placebo , the two groups were comparable at admission in terms of severity and duration of diarrhea , as well as nutritional and anthropometric parameters . The overall weight gain , stool volume , stool frequency , as well as the time taken for diarrheal recovery or steady weight gain , were comparable for both supplemented children and controls . Supplemented children had a significant improvement in plasma zinc levels and serum alkaline phosphatase by day 14 of therapy in comparison with controls . Plasma copper levels were low in both groups at admission and although an increase was seen in control children , levels decreased further after zinc supplementation . There was no significant difference between the two groups for hemoglobin , serum albumin , prealbumin , and plasma insulin-like growth factor-1 increments during the course of therapy . Evaluation of primary and secondary outcome criteria among the subset of children with plasma zinc levels < 60 μg/d at admission did not reveal any significant differences . Conclusions . Although there was satisfactory recovery in malnourished children with persistent diarrhea receiving the Khitchri-yogurt diet , there was no evidence of improved weight gain or acceleration of recovery from diarrhea with zinc supplementation . In contrast , the reduction in plasma copper levels in zinc-supplemented malnourished children suggests that caution should be exercised in supplementing severely malnourished children with zinc alone Zinc supplementation is recommended in all acute diarrheas in children from developing countries . We aim ed to assess whether zinc supplementation would be equally effective against all the common organisms associated with acute diarrheas . We used data on 801 children with acute diarrhea recruited in a r and omized , double blind controlled trial ( IS RCT N85071383 ) of zinc and copper supplementation .  Using prespecified subgroup analyses , multidimensionality reduction analyses , tests of heterogeneity , and stepwise logistic regression for tests of interactions , we found that the influence of zinc on the risk of diarrhea for more than 3 days depended on the isolated organism — beneficial in Klebsiella , neutral in Esherichia coli and parasitic infections , and detrimental in rotavirus coinfections . Although we found similar results for the outcome of high stool volume , the results did not reach statistical significance . Our findings suggest that the current strategy of zinc supplementation in all cases of acute diarrheas in children may need appropriate fine tuning to optimize the therapeutic benefit based on the causative organism , but further studies need to confirm and extend our findings Abstract Although oral rehydration therapy greatly reduces mortality from diarrhoeal diseases , it has little effect on stool frequency . However , there is mounting evidence that zinc is an effective adjunct to the treatment of diarrhoea , although few studies have examined its efficacy in Latin America . This study assessed the efficacy of zinc supplementation in children with acute diarrhoea in Brazil . The study was a double-blind , placebo-controlled , r and omised , clinical trial in children < 5 years of age attending emergency services in Sergipe , Brazil . Subjects received zinc or vitamin C as placebo . There was a marked reduction in the duration of the diarrhoea ( 1.1 vs 2.6 days ) and of watery stools in the zinc-supplemented group . The efficacy of zinc was independent of the presence of viral enteropathogens in the stools . It is concluded that , similar to studies in India and Bangladesh , zinc could be an important adjunct for treating acute diarrhoea in Brazilian children UNLABELLED Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children of developing countries . In a r and omized , placebo-controlled trial , we assessed the effectiveness and efficacy of giving 3 Recommended Daily Allowances of elemental zinc to 6- to 35-month-old children with acute diarrhea . METHODS Seventeen hundred ninety-two cases of acute diarrhea in Nepalese children were r and omized to 4 study groups . Three groups were blinded and the children supplemented daily by field workers with placebo syrup , zinc syrup , or zinc syrup and a massive dose of vitamin A at enrollment . The fourth group was open and the caretaker gave the children zinc syrup daily . Day-wise information on morbidity was obtained by household visits every fifth day . RESULTS The relative hazards for termination of diarrhea were 26 % ( 95 % confidence interval [ CI ] : 8 % , 46 % ) , 21 % ( 95 % CI : 4 % , 38 % ) , and 19 % ( 95 % CI : 2 % , 40 % ) higher in the zinc , zinc-vitamin A , and zinc-caretaker groups , respectively , than in the placebo group . The relative risks of prolonged diarrhea ( duration > 7 days ) in these groups were 0.57 ( 95 % CI : 0.38 , 0.86 ) , 0.53 ( 95 % CI : 0.35 , 0.81 ) , and 0.55 ( 0.37 , 0.84 ) ; zinc accordingly reduced the risk of prolonged diarrhea with 43 % to 47 % . Five percent and 5.1 % of all syrup administrations were followed by regurgitation in the zinc and zinc-vitamin A group , respectively , whereas this occurred after only 1.3 % of placebo administrations . Vomiting during diarrhea was also more common in children receiving zinc . CONCLUSIONS Three Recommended Daily Allowances of zinc given daily by caretakers or by field workers substantially reduced the duration of diarrhea . The effect of zinc was not dependent on or enhanced by concomitant vitamin A administration Diarrhoea remains one of the leading killers of young children . A recent meta- analysis demonstrated that a two-week course of zinc tablets once daily significantly reduces the severity and duration of diarrhoea and mortality in young children ( Bhutta et al. , 2000 . Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries : Pooled analysis of r and omized controlled trials . American Journal of Clinical Nutrition , 72(6 ) , 1516 - 1522 ) . Formative research is being conducted in a number of countries to prepare for the large-scale promotion of this new treatment . In-depth and semi-structured interviews with parents , community health workers , and traditional healers were conducted to examine the household management of diarrhoea in the Sikasso region of southern Mali in preparation for the introduction of a short-course of daily zinc for childhood diarrhoea at the community level . Supporting data from a subsequent household survey are also presented . Although nearly all parents knew oral rehydration solution ( ORS ) could replace lost fluids , its inability to stop diarrhoea caused parents to seek antibiotics from local markets , traditional medicines or anti-malarials to cure the illness . The notion of combining multiple treatments to ensure the greatest therapeutic benefit was prevalent , and modern medicines were often administered simultaneously with traditional therapies . As parents often deem ORS insufficient and judge that an additional treatment should be combined with ORS to cure diarrhoea , the concept of joint therapy of zinc and ORS should be well accepted in the community . Mothers-in-law and fathers , who play a significant role in decisions to seek treatment for sick children , as well as traditional healers , should also be considered when design ing new programs to promote zinc . Similarities with formative research conducted for a previous generation of diarrhoea control programmes are discussed The efficiency of a single two gram bolus of Ceftriaxone for cardiac operations was evaluated versus a classical , multiple dose , antibiotic prophylaxis using Cefam and ole . The results were quite similar in both groups , with a very low infection rate . We conclude that a single bolus prophylaxis using a broad spectrum antibiotic is as efficient as an ordinary , multiple dose technique Zinc is recommended for the treatment of acute diarrhea in children but the effect of its introduction on drug and oral rehydration solution use is unclear . Government care providers , private practitioners and community workers were trained to distribute zinc and oral rehydration solution to children seeking care for diarrhea . Periodic surveys showed that village-based workers became a common source of diarrhea treatment and private practitioners were used less . Zinc was used in approximately half of the episodes ; the prescription and use rates of oral rehydration solution packets increased from 7 % at baseline to 44.9 % 6 months later . Reduction in use of drugs during diarrhea ranged from 34 % for tablets to 64 % for injections 6 months later . The cost of treatment to families declined significantly . These findings need confirmation in a r and omized controlled trial Objectives : We assessed the effect of zinc for the treatment of diarrhoea implemented at the community level on physical growth among children 6 to 35 months of age . Methods : The service areas of 30 community health workers in the Matlab field site of International Centre for Diarrhoeal Disease Research , Bangladesh , were r and omly allocated to the intervention or comparison study arm . Between November 1998 and October 2000 , caretakers of 3- to 59-month-old children with diarrhoea in both intervention and comparison areas were offered oral rehydration solution and feeding advice , and severe episodes were referred for facility-based care . The caretakers of the children in the intervention area were additionally offered 20 mg/day elemental zinc for 14 days as adjunct treatment for each diarrhoea episode . Weight and length of children who were 6 to 11 months of age at the beginning of the study were measured every 2 months for 2 years . Rates of length and weight gains were compared between children living in intervention and control arms using a latent growth model . Results : Characteristics of children living in control and intervention areas were similar , except that more children living in intervention areas were underweight at baseline ( 44 vs 35 % ; P = 0.02 ) . Children living in intervention clusters gained slightly more weight and length than children in the control clusters ( 86.4 g/year and 2.8 mm/year , respectively ) . Conclusions : The therapeutic use of zinc along with oral rehydration solution for community-based diarrhoea management may have a small positive benefit on the rates of growth among children younger than 3 years of age Objective : To determine the effect of zinc supplementation on  diarrheal  incidence and to discover any operational constraints of zinc supplementation at the community level . Methods : We included 1712 children aged between 6 and 48 months in a r and omized double blind study in rural area comprising of 11 villages . Children were r and omly divided into 2 groups . Zinc/placebo syrup supplementation was continued for 6 months in a weekly schedule from May 2003 . Children were followed up weekly for detection of diarrhea from May 2003 until April 2004 . Around 30 % of the study children were evaluated every 2 months during supplementation period . Results : During the period , 80,534 weekly visits were made giving 1548.73-child years of observation . We detected 1438 diarrheal episodes among 846 children .  The incidence of diarrhea was significantly less during the supplemented period ( P < 0.001 ; RR 0.74 ( 0.64–0.87 ) ) in the zinc group . A significant difference was also noted during the follow up period ( P < 0.05 ) . In the zinc group , children < 2 years of age had significantly less diarrhea during supplementation and the follow up period . Multiple episodes of diarrhea ( ≥2 ) were significantly less in the zinc group . Approximately 85 % of the surveillance workers made weekly visits to the houses and 96 % of mothers administered syrup weekly to their children . Around 80 % of mother 's were aware of the possible benefits of zinc supplementation . Conclusion : Weekly zinc supplementation was effective in reducing diarrheal morbidity at the community level and it was operationally feasible BACKGROUND Intervention trials have shown that zinc may be efficacious in treating acute diarrhea in children of developing countries . A double-blind placebo-controlled study was design ed to evaluate the effects of zinc supplementation on the clinical course and duration of diarrhea in malnourished Turkish children . METHODS The study group comprised 40 subjects with low zinc levels ( Group 1a ) and 52 subjects with normal zinc levels ( Group 1b ) . The control group was also comprised of two subgroups : 36 subjects with low zinc levels ( Group 2a ) and 54 subject with normal zinc levels ( Group 2b ) . Forty-three percent of children in the study group and 40 % of controls had low serum zinc levels ( < 14 micromol/L ) , and 43 % of subjects in both groups had very low serum zinc concentrations ( < 10 micromol/L ) . The study group were given 20 mg zinc per day for 10 days and the control group were given 750 mg glucose per day as a placebo for 10 days . RESULTS The mean duration of diarrhea was shorter and the percentage of children with consistent diarrhea for more than 3 - 7 days was lower in the study subgroups than in the control subgroups . Prolonged diarrhea was present in 12 % of children in the study group , and in 44 % and 37 % of children in the hypozincemic and normozincemic control subgroups , respectively . The was no significant difference among the four subgroups of children in the number of cases with post-enrollment diarrhea of a duration of>14 days . Stool frequency over the first 4 days after enrollment was lower in children in the study group . CONCLUSION It was concluded that zinc supplementation in malnourished children with acute diarrhea may reduce the severity and duration of diarrhea , especially in children with low zinc levels Objective : Assess the impact of zinc supplementation with locally developed culturally specific educational statements ( messages ) on oral rehydration solution ( ORS ) and antibiotics or antidiarrheal use in children with acute watery diarrhea as well as to assess adherence and side effects of zinc . Methods : This was a r and omized effectiveness trial conducted in outpatient health facilities of six sites in five countries , namely , Fortaleza ( Brazil ) , Addis Adaba ( Ethiopia ) , Cairo ( Egypt ) , Lucknow and Nagpur ( India ) , and Manila ( Philippines ) . Participants were 2,002 children aged 2 to 59 months . Intervention was zinc ( 20 mg orally , once daily for 14 days ) with ORS ( zinc group ) compared with ORS alone ( control group ) . Primary outcomes were  ORS use on day 3 to 5 ; adherence to zinc ; and any use of an antibacterial/antidiarrheal up to day 14 . Results : One thous and ten and 992 children enrolled in zinc and control groups , respectively . Loss to follow-up on days 3 to 5 and 15 to 17 was 1.2 % and 2.8 % in the zinc group and 0.8 % and 1.7 % in the control group . In five of six sites , ORS use in cases with continued diarrhea on days 3 to 5 was the same in the two groups or higher in zinc group . Overall adherence to zinc supplementation was 83.8 % ( 95 % confidence interval [ CI ] 81 - 86 ) . There was no difference in vomiting by group . In consideration of the six countries overall , less antibiotic/antidiarrheal use occurred in the zinc group ( absolute difference , 3.8 % [ 95 % CI 1.7 - 5.9 ] ) . Conclusions : In the management of acute watery diarrhea , zinc plus ORS along with culturally appropriate , site-specific messages in local language does not affect overall  ORS  use generally and decreases antibiotic/antidiarrheal use ; children had good adherence without side effects OBJECTIVE To determine the efficacy of zinc-fortified oral rehydration salts solution ( ORS ) in comparison to ORS without zinc in 6- to 35-month-old urban children with acute diarrhea not sick enough to be hospitalized . DESIGN Double-blind , r and omized , controlled trial . METHODS Children ( n = 1219 ) with acute diarrhea were r and omly assigned to one of 3 groups . The first group received a zinc syrup ( 15 mg zinc to 6- to 11-month-old children and 30 mg to 12- to 35-month-old children ) , the second group received zinc premixed with ORS ( 40 mg/L ) , and the control children received ORS only . Households were visited twice weekly until recovery . RESULTS The total number of stools was lower in the zinc-ORS group ( rate ratio , 0.83 ; 95 % CI , 0.71 - 0.96 ) , as was the proportion of children with watery stools ( odds ratio , 0.61 ; 95 % CI , 0.39 - 0.95 ) , compared with the control group ; there was no significant effect on diarrheal duration . ORS intake and proportion of children with vomiting were not significantly different between the zinc-ORS and control groups . The zinc syrup group had lower diarrheal duration ( relative hazards , 0.89 ; 95 % CI , 0.80 - 0.99 ) and total stools ( rate ratio , 0.73 ; 95 % CI , 0.70 - 0.77 ) than control children . CONCLUSIONS Zinc-ORS was moderately efficacious in reducing the severity of acute diarrhea without increasing vomiting or reducing ORS intake Abstract We design ed a double-blinded r and omized clinical trial of zinc ( 10 or 20 mg of zinc sulphate for 2–5 month-old or 6–59 month-old children , respectively , during 10 days ) vs. placebo in otherwise healthy children aged 2 months to 5 years who presented with acute diarrhoea ( i.e. ≥3 stools/day for less than 72 h ) . Eighty-seven patients ( median age 14 months ; range 3.1–58.3 ) were analysed in an intention-to-treat approach . Forty-two patients took zinc  and 45 placebo . There was no difference in the duration nor in the frequency of diarrhoea , but only 5 % of the zinc group still had diarrhoea at 120 h of treatment compared to 20 % in the placebo group ( P = 0.05 ) . Thirty-one patients ( 13 zinc and 18 placebo ) were available for per- protocol analyses . The median ( IQR ) duration of diarrhoea in zinc-treated patients was 47.5 h ( 18.3–72 ) and differed significantly from the placebo group ( median 76.3 ; IQR 52.8–137 ) ( P = 0.03 ) . The frequency of diarrhoea was also lower in the zinc group ( P = 0.02 ) . Conclusion : zinc treatment decreases the frequency and severity of diarrhoea in children aged 2 months to 5 years living in Switzerl and . However , the intention-to-treat analysis reveals compliance issues that question the proper duration of treatment and the choice of optimal pharmaceutical formulation . What is known• The effectiveness of zinc  in childhood diarrhoea has been demonstrated in developing countries . It helps to decrease the duration and severity of diarrhoea . There is currently no sufficient data to justify its use in developed countries , where there is , theoretically , no zinc deficiency . What is new• We demonstrated the effectiveness of zinc  in diarrhoea of children living in a developed country . This confirms the result of two studies ( Passariello 2011 , and Dalgic 2011 ) that also reported the positive impact of zinc in diarrhoea of children living in Italy and in Turkey . However , our population is wider in terms of age ( 2–60 months compared to 3–36 months for Passariello ’s study and 1–28 months for Dalgic ’s study ) and is not limited to a specific aetiology or to a certain degree of severity of the diarrhoea . Furthermore , it ’s the first study that uses a placebo for the control group . The main limitation of our study is the differences in the intention-to-treat and the per- protocol analyses that reveal big compliance problems . These could be dealt by changing the dosage form of the zinc formula and /or by diminishing the treatment duration
Diarrhea prevalence on days 3 , 5 , and 7 was lower in the zinc group .
The incidence of vomiting was significantly greater in the group that received zinc than in the control group .
CONCLUSIONS Oral zinc supplementation significantly decreases diarrhea duration and has a greater effect on malnourished children .
OBJECTIVE To up date the available evidence about zinc use for treating diarrhea in children and to assess its effect on the malnourished population , a subgroup that has not been fully explored in previous analyses .