Zinc supplementation in the management of shigellosis in malnourished children in Bangladesh

Objective: To assess the impact of zinc supplementation on clinical recovery, weight gain and subsequent growth and morbidity in moderately malnourished children with shigellosis. Design: A randomized, double-blind, controlled trial. Setting: Dhaka hospital of ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh. Subjects: Fifty-six moderately malnourished children, aged 12-59 months with culture-proven shigellosis. Methods: Subjects were randomly allocated to receive zinc (20mg/day elemental) in multivitamin syrup (intervention) or multivitamin syrup without zinc (control) in two equally divided doses daily for 2 weeks. All children received pivmecillinam in a dose of 15mg/kg every 6h for 5 days. After supplementation, children were followed in their respective homes every 2 weeks for 6 months. Results: Children receiving zinc recovered from acute illness significantly faster than the control children (P<0.05). The medians time (days) to recovery and disappearances of blood and mucous were significantly 50% shorter in the zinc-supplemented group compared to the control group. The mean body weight of zinc supplemented children increased significantly from 8.8kg on admission to 9.2kg (P<0.01) at recovery, which was not observed in the control children (from 9.3 to 9.6 kg; P=0.12). During the 6-month follow-up period, zinc-supplemented children had significantly fewer mean episodes of diarrhoea compared to the control children (2.2 vs 3.3; P=0.03). Conclusion: Zinc supplementation significantly shortens the duration of acute shigellosis, promotes better weight gain during recovery and reduces diarrhoeal morbidity during the subsequent 6 months.