Oral Zinc as an Adjunct in the Treatment of Enteric Fever: A Randomised Double-blinded Controlled Trial

Abstract

Introduction: Enteric fever is an important tropical disease which takes an average of five days for defervescence even with effective antibiotic therapy. Zinc has been successfully used as an adjuvant in diarrhoeal disease. If addition of oral zinc can lead to reduction in time to defervescence, it will be a useful adjuvant in the therapy of enteric fever. Aim: To determine the effect of oral zinc supplementation, along with standard antibiotic therapy, for early defervescence among children with enteric fever. Materials and Methods: This double-blinded, randomised controlled trial was conducted at the Department of Paediatrics, ESICMC and PGIMSR, Chennai, Tamil Nadu, India from November 2014 to August 2016. A total of 58 children aged <12 years with enteric fever were included and were randomised to receive 40 mg elemental zinc per day (n=29) or placebo (n=29) for one week. All children received intravenous ceftriaxone (75 mg/ kg every 12 hours) until five days after defervescence. The main outcome measures studied were time taken for defervescence of fever and resolution of toxaemia. Kaplan-Meier survival analysis was used to compare differences in the time to resolution of toxaemia and defervescence of fever between the two groups and the log-rank test was used to test for significance. Results: The mean age of the children of the two groups was 6.48±3.15 years and 7.55±2.59 years, respectively. The mean time for fever defervescence was shorter among the zinc supplemented children than among the children in the control group (2 vs 3 days, p-value=0.043). Resolution of toxaemia was noted earlier in the zinc group than in the control group (75% vs 43%, p-value=0.054). Conclusion: Zinc when used as an adjunct along with standard antibiotic therapy in children with enteric fever, resulted in earlier defervescence of fever.