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Lower doses of zinc provide similar results while reducing vomiting.
Lower doses of zinc are just as effective in treating childhood diarrhea while decreasing vomiting, according to a recent study published in The New England Journal of Medicine.
While there has been a 90% decline in diarrhea-related deaths since 1980, approximately half a million children died of diarrhea in 2018. The World Health Organization currently recommends 20 mg of zinc for 10 to 14 days for children with acute diarrhea. Previous trials found that while this dosage decreases diarrhea, it increases vomiting, according to the study.
The randomized, multicenter study focused on 4500 children in Indian and Tanzania who were aged 6-59 months and had acute diarrhea. Each child was assigned 5 mg, 10 mg, or 20 mg of zinc sulfate for 14 days. According to the study, the 3 primary outcomes were a diarrhea duration of more than 5 days, the number of stools, and the number of vomiting within 30 minutes after zinc administration.
Children with diarrhea for more than 5 days was 6.5% in the 20 mg group, 7.7% in 10 mg group, and 7.2% in the 5 mg group, according to the study. The mean number of diarrheal stools was similar across all 3 groups. For the 20 mg group, the mean number of stools was 10.7, for the 10 mg group it was 10.9, and 10.8 in the 5 mg group. However, as the dosage of zinc decreased, so did the rate of vomiting within 30 minutes after administration. In the 20 mg group, 19.3% experienced vomiting within 30 minutes. For the 10 mg group, 15.6% had this adverse effect, and 13.7% of the 5 mg group experienced vomiting after administration.
“In our trial, we found that children with acute diarrhea receiving 5 mg or 10 mg per day of supplemental zinc had diarrhea outcomes similar to those in children receiving 20 mg but had less vomiting,” study authors wrote.
Investigators found that children in India appeared to benefit more from lower zinc doses with respect to vomiting than children in Tanzania. This may be due to several unmeasured factors, according to the study. For example, the Tanzanian children tended to be younger and more well-nourished compared to the Indian children in the study.
Dhingra, Usha, MA, MCA et al. Lower-Dose Zinc for Childhood Diarrhea — A Randomized, Multicenter Trial [Journal Article] The New England Journal of Medicine; September 24, 2020. DOI: 10.1056/NEJMoa1915905. Accessed September 24, 2020.