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The prophylactic and therapeutic effectiveness of zinc sulphate on common cold in children
Abstract
To determine the efficacy of prophylactic administration of zinc sulphate in reducing the occurrence of the common cold in children, and to evaluate the efficacy of zinc sulphate in reducing the duration and severity of cold symptoms.
A total of 200 healthy children were randomly assigned to receive oral zinc sulphate (zinc group, n=100) or placebo (placebo group, n=100). Zinc sulphate (15 mg of zinc) or placebo syrup were administered for prophylaxis once daily during a 7-mo study period. The dose was increased to two times per day (30 mg of zinc) at the onset of cold, until symptoms resolved.
The mean number of colds in the zinc group was significantly less than in the placebo group (1.2 vs 1.7 colds per child; p=0.003). The mean cold-related school absence was 0.9 d per child in the zinc group versus 1.3 d in the placebo group (p=0.04). Compared to the placebo group, the zinc group had shorter mean duration of cold symptoms and decreased total severity scores for cold symptoms (p<0.0001). Adverse effects were mild and similar in both groups.
Zinc sulphate appears to be an easily administered, safe and well-tolerated alternative for the prevention and treatment of the common cold in children.
... Positive effects of zinc supplementation were found [100][101][102] in those people who started taking it soon after their symptoms started and who utilized products without citric or tartaric acid. Zinc may not be any more effective than a placebo in treating the common cold, according to a meta-analysis 103 published between 1996 and 2006. In a more recent randomized controlled trial 103 , zinc supplementation significantly reduced symptom severity but not duration in Turkish children who began supplementation soon after cold symptoms arose. ...
... Zinc may not be any more effective than a placebo in treating the common cold, according to a meta-analysis 103 published between 1996 and 2006. In a more recent randomized controlled trial 103 , zinc supplementation significantly reduced symptom severity but not duration in Turkish children who began supplementation soon after cold symptoms arose. A second recent study used zinc lozenges (13.3 mg of zinc acetate every 2 to 3 hours while awake) or a placebo in a randomized controlled experiment including adults. ...
... Lozenges made from zinc gluconate and glycine are generally well tolerated and safe 103 ; however, there are side effects like a metallic taste, nausea, and stomach distress in some users. Lozenges pose a choking hazard and should not be given to children under the age of three. ...
In the present study, we reviewed the efficacy of traditional herbal formulas on human immunity. A literature survey was performed in PubMed, UpToDate, Proquest Central Databases of Kırıkkale University, Google and Google Scholar databases from the internet. Search key words were "immune", "immune system", "herbal", "Pelargonium Sidoides", "Echinacea Purpurea", "Sambucus Nigra", "Beta Glucan", "Vitamin C", "Zinc". The immune system is a natural self-defense mechanism made up of cells that assist the body in distinguishing between self and non-self-molecules. All immune system components must be regularly modified in order to keep the body defenses up against the ever-evolving microbes that are constantly looking for new ways to attack the host. A Chinese herbal formulation is a combination of several herbs. The practitioner begins with one or two major substances that are intended to treat the ailment. The reproducibility of the efficacy of herbal medicines is dependent on the consistency of the quality of each unique raw herb. Pelargonium Sidoides, Echinacea Purpurea, Sambucus Nigra, Beta Glucan, Vitamin C, and Zinc are some herbal treatments utilized for their benefits on human immunity. Herbal remedies are undoubtedly valuable in boosting impaired immune function, particularly where damage has occurred due to malnutrition, chronic disease or previous infections. At present, however, an invincible immune system remains firmly in the realm of fantasy.
... The search strategy yielded 3928 unique publications once duplicates were removed across databases (Supplementary File S2). Thirty-nine RCT studies (across 43 publications) met eligibility criteria including eight dietary supplement ingredients: echinacea (N = 6; n = 1708 subjects) [14][15][16][17][18][19], elderberry (N = 1; n = 312) [20], garlic (N = 2; n = 266) [21][22][23], vitamin A (N = 2; n = 1719) [24,25], vitamin C (N = 3; n = 237) [26][27][28], vitamin D (N = 18; n = 19,309) [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48], vitamin E (N = 1; n = 652) [49,50] and zinc (N = 6; n = 1445) [51][52][53][54][55][56], involving populations including children, adults and seniors, exposed to stressors described as stressful air travel, intense exercise, academic stress, exposure to winter months, environmental stressors such as poor living environments or where deficiency in certain nutrients is prevalent, and subjects inoculated with a virus. After title and abstract screening, the authors decided to exclude prebiotic and probiotic studies from this current review due to complexities in which these ingredients are categorized/defined in terms of dietary supplements vs. food sources. ...
... Four studies (n = 1355 participants) included school aged children up to the age of 15 years, living outside of the US who took various forms of zinc for up to seven months, to include the winter months. Children took between 10-20 mg/day of zinc in the forms: zinc bisglycinate-Qualimed, Thailand [53], elemental zinc [55], and zinc sulphate supplied by Berko Ilac Company, Turkey [51] or a Peruvian pharmaceutical Lab (Instituto Quimioterapico, Peru) [54]. According to Kurugol et al. [51] if children experienced symptoms, they were given 30 mg/day for up to 10 days rather than 15 mg/day during the prevention stage. ...
... Children took between 10-20 mg/day of zinc in the forms: zinc bisglycinate-Qualimed, Thailand [53], elemental zinc [55], and zinc sulphate supplied by Berko Ilac Company, Turkey [51] or a Peruvian pharmaceutical Lab (Instituto Quimioterapico, Peru) [54]. According to Kurugol et al. [51] if children experienced symptoms, they were given 30 mg/day for up to 10 days rather than 15 mg/day during the prevention stage. One study involved 40 male and female US Air Force cadets during the cold and flu season who were exposed to a number of stressful situations during their training; participants took 15 mg zinc supplied through a "FDA licensed clinical specialty pharmacy (FL, USA)" for seven months duration [56]. ...
Immune health products represent approximately 10% of all US dietary supplement sales. Claims made on products to support or boost the immune system are attractive to the otherwise healthy consumer who may or may not be experiencing certain life stressors. The purpose of this systematic review is to critically evaluate the purported benefits and/or potential harms of select dietary supplement ingredients frequently listed on the labels of products having immune health or related market claims. With a focus on resilience, research questions were related to whether dietary supplement ingredients are efficacious in preserving and protecting immune health in healthy individuals; and when faced with a stressor, whether taking a supplement prophylactically can assist in maintaining health and resisting or bouncing back more quickly. Thirty-nine randomized controlled studies involving populations including children, adults and seniors exposed to stressors, such as air travel, intense exercise, academic stress, and/or exposure to winter weather, met eligibility criteria. The studies included eight of the 27 supplement ingredients identified through a market-driven scoping review. Those ingredients used in single ingredient products were echinacea, elderberry, garlic, vitamin A, vitamin C, vitamin D, vitamin E, and zinc. Whereas some studies may point to evidence for benefit, specific gaps preclude the authors from making firm statements with regard to the overall evidence-base for these products and ingredients and in answering the research questions. As we move toward a vision of health promotion and resilience rather than a sole focus on disease prevention and treatment, further work in this area of dietary supplements is of utmost importance.
... En nutrición infantil se utilizan varios tipos de compuestos de zinc (4), siendo el sulfato de zinc uno de los más usados. A pesar de su seguridad y baja toxicidad, estos compuestos pueden desencadenar efectos secundarios como náuseas, vómitos y dolor abdominal (15)(16)(17), sin mencionar su sabor desagradable, por lo que es necesario buscar vehículos que enmascaren su sabor para administrarlo a niños. ...
... Antes de comenzar la intervención, 50 % de los niños tenía un peso de 15,6 kg o menos (Rq=3,03 kg) y una talla de 99,0 cm o menos (Rq=9,4 cm); cuando se comparó la clasificación nutricional de los niños al comienzo del estudio y los indicadores antropométricos de talla para la edad, peso para la edad, peso para la talla e 9) 50 (16,6) 96 (31,9) 155 (51, 5) 90 (29,9) 192 (63, 8) 19 (6,3) 123 (40, 9) 39 (12,9) índice de masa corporal (IMC) para la edad con base en el modelo de puntuación z y de acuerdo a los patrones de crecimiento de la OMS (20), no se encontraron diferencias significativas (prueba de χ² de independencia, p>0,05) (cuadro 3). ...
... En otro estudio, Kurugol, et al., evaluaron la eficacia del sulfato de zinc (15 mg de sulfato de zinc, seis días por semana durante siete meses) en la reducción de la ocurrencia de resfriado en niños. La proporción de la incidencia de resfriado fue de 33 % en el grupo placebo y de 14 % en el grupo que consumió zinc (RR=0,4; IC 95% : 0,2-0,6, p≤0,05) (16). En el presente estudio se encontró menor incidencia no significativa en el grupo que consumió sulfato de zinc comparado con el grupo placebo (RR=0,47, IC 95% : 0,233 a 0,975, p=0,057). ...
Introducción. El déficit de zinc es común en niños de poblaciones en desarrollo. La deficiencia de zinc altera el sistema inmunológico y la resistencia a las infecciones.
Objetivo. Evaluar el efecto de dos compuestos de zinc en la prevención de la infección respiratoria y la diarrea agudas.
Materiales y métodos. Se llevó a cabo un ensayo comunitario triple ciego en 301 niños entre dos y cinco años de edad de centros infantiles de Medellín. Fueron seis conglomerados distribuidos aleatoriamente en tres grupos de intervención que recibieron zinc aminoquelado, sulfato de zinc y placebo durante cinco días de la semana a lo largo de 16 semanas. Se evaluaron diariamente los síntomas de infección respiratoria, diarrea aguda y efectos secundarios.
Resultados. La incidencia de la infección respiratoria fue menor con el zinc aminoquelado (1,42 por 1.000 días-niño) comparado con el sulfato de zinc (1,57 por 1.000 días-niño) (RR=0,90, IC95%: 0,382 a 2,153, p=0,999) y con el placebo (3,3 por 1.000 días-niño) (RR=0,43, IC95%: 0,196 a 0,950, p=0,049). La incidencia de diarrea aguda con el zinc aminoquelado (0,15 por 1.000 días-niño) fue menor que con el sulfato de zinc (1,18 0,78 por 1.000 días-niño) (RR=0,20, IC95%: 0,0043 a 1,662, p=0,361) y que la del grupo placebo (0,49 por 1.000 días-niño) (RR=0,32, IC95%: 0,006 a 3,990, p=0,346).
Conclusiones. El zinc aminoquelado tuvo mejor efecto en la disminución de la incidencia de la infección respiratoria y la diarrea agudas en niños preescolares comparado con los otros grupos de estudio.
Identificador en clinicaltrials.gov: NCT01791608
... Metal ions and metal-ion-containing substances can modulate physiological or pathological immune responses for the treatment of disease, and thus provide opportunities for immunotherapies. Although metal ions and metal salts (such as alum adjuvant and Zn supplements) have been used to modulate immune processes for disease treatment or prevention 22,23 , strategies for enhancing immunotherapies by incorporating metal ions have not been sufficiently explored. Moreover, general guidelines for the development of such metalloimmunotherapies are lacking. ...
... Zn 2+ has been widely used for cold remedies. Although the results vary across study conditions and clinical trials, Zn 2+ seems to be effective in shortening the duration of disease when administered within 24 h of the onset of symptoms, and it may also have a prophylactic effect in children 23 . The mechanism is unclear, yet it is thought to be related to inhibition of viral replication, viral binding of ICAM-1 and improved host immunity through cytokine production and enhanced T cell function. ...
Metal ions play crucial roles in the regulation of immune pathways. In fact, metallodrugs have a long record of accomplishment as effective treatments for a wide range of diseases. Here we argue that the modulation of interactions of metal ions with molecules and cells involved in the immune system forms the basis of a new class of immunotherapies. By examining how metal ions modulate the innate and adaptive immune systems, as well as host–microbiota interactions, we discuss strategies for the development of such metalloimmunotherapies for the treatment of cancer and other immune-related diseases.
... Pre efekt liečby je však nevyhnutná skorá aplikácia, a to už v priebehu prvých 12-24 hodín od začiatku prodromálnych príznakov. Odporúča sa aplikácia zvý šenej dávky, minimálne 75 mg zinku denne u dospelého pacienta po dobu 5 dní [21, [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Použitie zinku v liečbe akútnej rinosinusitídy odporúčajú aj medzinárodné smernice na liečbu akútnej rinosinusitídy -European Position Paper on Rhinosinusitis [38,39]. ...
... Pri dlhodobom podávaní zinku boli zaznamenané aj jeho preventívne účinky pred vznikom častých infekcií horných dýchacích ciest. Zinok nielen znížil frekvenciu infekcií [36,[44][45][46], ale pozitívne ovplyvnil aj sekundárne nepriame ukazovatele, napríklad zredukoval absenciu v škole/ práci a znížil potrebu antibio tickej liečby [24]. Preventívny aj liečebný účinok zinku bol dokázaný pre rôzne vekové kategórie [31,47]. ...
Zinok má komplexné imunomodulačné, protivírusové, protizápalové a cytoprotektívne účinky, preto patrí medzi efektívne spôsoby liečby a prevencie respiračných vírusových infekcií. Lekárnik je zdravotnícky pracovník, ktorý najčastejšie a ako prvý rieši samoliečbu
rôznych respiračných infekcií. Tie sú takmer vždy spôsobené vírusmi. Článok opisuje úlohu zinku pre správne fungovanie imunitného systému, vrátane mechanizmov jeho protivírusového pôsobenia. Lekárnik môže odporúčať zinok v liečbe akútnych infekcií horných dýchacích ciest (napr. prechladnutie), alebo ako doplnkovú liečbu a prevenciu iných respiračných infekcií či chronických respiračných ochorení s predpokladom deficiencie zinku. V článku sa tiež uvádza možné využitie zinku ako súčasti liečby a prevencie ochorenia covid-19.
Kľúčové slová
zinok – respiračné infekcie – protivírusový účinok – lekárnik
Zinc has complex immunomodulatory, antiviral, anti-inflammatory and cytoprotective effects, making it an effective way of treating and preventing respiratory viral infections. Pharmacists are the first-line healthcare professionals frequently handling self-treatment of various respiratory infections, which are almost always caused by viruses. The article describes zinc’s role in the immune system being able to function correctly, including its antiviral mechanisms of action. A pharmacist may recommend zinc to treat acute upper respiratory tract infections, such as the common cold, or as adjunctive therapy, and to prevent other respiratory infections or chronic respiratory diseases with a presumption of zinc deficiency. The article also discusses the possible use of zinc as part of treatment and prevention of covid-19.
Key words
zinc – respiratory infections – antiviral effect – pharmacist
... From the early 2000s, various studies were conducted, mainly in children from lower socio-economic settings, to establish whether daily or weekly zinc supplementation could help in preventing respiratory tract infections (Table 9) [269][270][271][272][273][274][275][276][277][278][279][280][281]. ...
... Different studies reported a reduced incidence of respiratory infections in the zinc receiving group [269,[271][272][273]280]. In 2007, Sazawal et al. reported a slight reduction in the relative risk of all-cause mortality in children supplemented with zinc in Zanzibar [277]. ...
Viral infections are a leading cause of morbidity and mortality worldwide, and the importance of public health practices including handwashing and vaccinations in reducing their spread is well established. Furthermore, it is well known that proper nutrition can help support optimal immune function, reducing the impact of infections. Several vitamins and trace elements play an important role in supporting the cells of the immune system, thus increasing the resistance to infections. Other nutrients, such as omega-3 fatty acids, help sustain optimal function of the immune system. The main aim of this manuscript is to discuss of the potential role of micronutrients supplementation in supporting immunity, particularly against respiratory virus infections. Literature analysis showed that in vitro and observational studies, and clinical trials, highlight the important role of vitamins A, C, and D, omega-3 fatty acids, and zinc in modulating the immune response. Supplementation with vitamins, omega 3 fatty acids and zinc appears to be a safe and low-cost way to support optimal function of the immune system, with the potential to reduce the risk and consequences of infection, including viral respiratory infections. Supplementation should be in addition to a healthy diet and fall within recommended upper safety limits set by scientific expert bodies. Therefore, implementing an optimal nutrition, with micronutrients and omega-3 fatty acids supplementation, might be a cost-effective, underestimated strategy to help reduce the burden of infectious diseases worldwide, including coronavirus disease 2019 (COVID-19).
... Although cold is usually a self-limited and uncomplicated disease, the symptoms and their duration could cause numerous problems for children and their families. Among problems caused by colds, the following could be suggested: social dysfunction due to physical health problems, such as absenteeism from school and kindergarten, impatience, nutritional problems, weight loss, increased risk of secondary bacterial infections in children, increased burden on families and community, increased physician visits, and more frequent visits to the health care system (16)(17)(18). ...
... In a systematic review and meta-analysis of randomized controlled trial (2012), which examined the effect of zinc sulfate on the common cold, the results showed that zinc sulfate had a positive impact on the duration of cold symptoms (15). Various researchers in their studies have suggested using zinc sulfate as a prophylactic approach; for instance, in a study conducted by KurugoL et al., the results showed that the number of people affected by cold as well as the severity and duration of cold was significantly lower in the persons, who received zinc sulfate during the study period as a prophylactic treatment, as compared with patients, who were taking the placebo (16). ...
Background
Cold is defined as a viral infection of the upper respiratory tract. The disease is more common in children than in adults and usually requires greater attention and care.
Methods
This double-blind randomized placebo-controlled trial (zinc versus placebo of zinc) was carried out using a repeated measures design. After excluding the cases that met the exclusion criteria, data was collected from 120 participants and analyzed. The study was conducted over a period of 3 months (June 2015 to August 2015). The intervention group received Zinc (1 mg/kg) for 7 days and the control group received the same amount of placebo.
Results
The durations of runny nose and nasal congestion was significantly shorter in patients in the intervention group, who had received zinc, when compared with the control group (P = 0.017 and P = 0.001, respectively). Moreover, there were significant differences between patients, who received zinc and those, who did not receive the drug, in terms of the duration, severity of signs and symptoms, severity of illness, and weakness (P = 0.018).
Conclusions
Based on the results of this study and other similar studies, zinc sulfate has positive effects on children with colds. Thus, the results of these studies could be utilized by medical teams to adopt a more accurate and complete clinical approach towards the use of zinc sulfate for patients with colds.
... Common cold is the most common disease in children. Cold in early childhood occurs 5-7 times per year, compared with adults 2-4 times per year (2). Among etiologic factors of the disease, hundreds of different species of viruses are the factors that about 90 percent cause upper respiratory infection. ...
... Among etiologic factors of the disease, hundreds of different species of viruses are the factors that about 90 percent cause upper respiratory infection. The viruses can enter the body through mucous membranes of the nose or eyes (2). According to the symptoms caused by common cold, the disease creates numerous problems for children and their families such as weight loss and probability of having secondary bacterial infections by creating restlessness and interference in nutrition. ...
At the age of 1-7 years, the common cold is prevalence among children. It usually happens 6 to 7 times a year among children. An effective and safe drug is needed to reduce the duration of common colds symptoms in children and reduce subsequent complications. In some studies, zinc sulfate has showed an antiviral effect and immune enhancing activity. Therefore, this study was designed to evaluate the efficacy of zinc sulfate in duration of colds’ symptoms in children. In this study, 112 children with common cold who are between 6-7 years old divided into two groups. Case group received zinc sulfate within 10 days and Control group didn’t receive this drug. The symptoms like rhinorrhea and nasal obstruction, cough, sneezing, fever and duration of illness were checked out in both groups by questionnaire. In children with common cold, a significant decrease was observed in the mean duration of rhinorrhea, cough and nasal obstruction. Compared to the group that didn’t receive zinc sulfate, the zinc group had shorter mean duration of sneezing and fever. The mean duration of illness in patients who had received the zinc sulfate was significantly less than the other group. No side effect was observed in subjects received zinc sulfate. Based on our result, zinc sulfate can be administered with other supportive treatments of common cold, for reduction of symptoms duration and complications in children.
... This study has showed zinc prophylactic effectiveness. [18] Another example is a cohort study that tried to define the relationship between zinc intake and the likelihood of contracting the common cold. Daily consumption of vitamin C and zinc was evaluated initially using a dietary survey, the reliability and consistency of which were established in a subset of the community. ...
The common cold is a widespread and frequent illness with limited treatment options, generating costs for individuals and society. A crucial goal is an effective symptomatic treatment and reducing the duration of the illness, which can bring significant global benefits. Several studies suggest that using zinc lozenges within 24h of symptom onset can noticeably shorten the duration of symptoms. Zinc has a complex and not fully understood role in immune regulation. Zinc lozenges are inexpensive, easily accessible, and has few side effects. Based on numerous studies, zinc lozenges seem to be a noteworthy option for symptomatic treatment. The application of therapy in athletes can be of particular importance due to the faster recovery and the avoidance of missing training sessions.
... Zinc also inhibits Rhinovirus RdRp activity in vitro although the mechanism remains to be understood (Korant et al., 1974;Hung et al., 2002). Clinical trials have shown the therapeutic benefit of zinc in alleviating rhinovirus induced common cold symptoms (Eby et al., 1984;Hulisz, 2004;Kurugöl et al., 2006). Zinc inhibits HIV-1 (Human immunodeficiency virus-1) protease and reverse transcriptase activity (Zhang et al., 1991;Haraguchi et al., 1999;Fenstermacher and DeStefano, 2011). ...
Viral hepatitis is a major public health concern globally. World health organization aims at eliminating viral hepatitis as a public health threat by 2030. Among the hepatitis causing viruses, hepatitis B and C are primarily transmitted via contaminated blood. Hepatitis A and E, which gets transmitted primarily via the feco-oral route, are the leading cause of acute viral hepatitis. Although vaccines are available against some of these viruses, new cases continue to be reported. There is an urgent need to devise a potent yet economical antiviral strategy against the hepatitis-causing viruses (denoted as hepatitis viruses) for achieving global elimination of viral hepatitis. Although zinc was known to mankind for a long time (since before Christ era), it was identified as an element in 1746 and its importance for human health was discovered in 1963 by the pioneering work of Dr. Ananda S. Prasad. A series of follow up studies involving zinc supplementation as a therapy demonstrated zinc as an essential element for humans, leading to establishment of a recommended dietary allowance (RDA) of 15 milligram zinc [United States RDA for zinc]. Being an essential component of many cellular enzymes and transcription factors, zinc is vital for growth and homeostasis of most living organisms, including human. Importantly, several studies indicate potent antiviral activity of zinc. Multiple studies have demonstrated antiviral activity of zinc against viruses that cause hepatitis. This article provides a comprehensive overview of the findings on antiviral activity of zinc against hepatitis viruses, discusses the mechanisms underlying the antiviral properties of zinc and summarizes the prospects of harnessing the therapeutic benefit of zinc supplementation therapy in reducing the disease burden due to viral hepatitis.
... The results regarding the effects of zinc on the improvement of respiratory diseases are contradictory. Some studies have reported significant and positive effects of zinc on reducing respiratory infections (30)(31)(32), while several other studies have indicated no positive impacts of zinc supplements on the risk of respiratory infections and the process of recovery and death (33,34). Since zinc inhibits RNA-dependent RNA polymerase in vitro, this micronutrient is likely to be effective in inhibiting COVID-19 infection (35). ...
Patients with coronavirus 2019 (COVID-19) are likely to experience a wide range of mild to severe symptoms that can lead to hospitalization or even death. Infection and poor nutrition are potentially interdependent. The immune response to infection is associated with increased demand for nutrients. Also, micronutrient supplementation can improve the body's defence against infections. This review of the literature was conducted to ascertain published studies on the relationship between micronutrients and the risk of COVID-19 or their effect on the recovery process of hospitalized COVID-19 patients. The findings from these papers show that patients who were deficient in vitamin D, vitamin C, selenium and zinc were likely to display more severe forms of COVID-19. Vitamin D seems to have the most significant impact when consumed in equal bolus before the development of COVID-19. Intravenous injection of vitamin C in COVID-19 patients admitted to the ICU at a dose of 24 gram in 24 hours was significantly associated with improved COVID-19. Selenium intake with vitamin D and zinc reported in COVID-19 patients with Hashimoto's thyroiditis infection positively affected the recovery process. More studies are required on group B vitamins due to their proven immune-boosting effect. Finally, there is a need to conduct clinical trials with higher power and subsequent meta-analysis studies in order to be able to make a definite statement about the effectiveness of micronutrients on the COVID-19 progression.
... Esto igualmente ha sido reportado por Alexander y colaboradores, quienes evidenciaron que una intervención temprana con cinc aumenta la resistencia antiviral contra la progresión del COVID-19 y disminuye los niveles de citocinas proinflamatorias IL-6, IL-8 y TNFα (44) . Otros estudios evaluaron el efecto de la suplementación con cinc en enfermedades virales y encontraron un efecto profiláctico y una duración reducida de los síntomas (41,45,46) , mientras que otros estudios no informaron un efecto convincente sobre la carga viral o la respuesta inmunitaria (40) . ...
Las opciones terapéuticas en el manejo de coronavirus disease 2019 (COVID-19) son limitadas y el proceso de vacunación para proteger contra el contagio del coronavirus del síndrome respiratorio agudo grave de tipo 2 (SARS-CoV-2) está iniciando en el mundo. A todo esto, hay que añadir la existencia de un grupo de personas
que presentan mayor vulnerabilidad frente a la enfermedad, como son los adultos mayores y las personas con enfermedades crónicas como la obesidad, la diabetes y la hipertensión arterial.
... Another research showed that zinc contributed to shorten the duration of common colds and other viral diseases (Eby et. al. 1984); Kurugöl et al., 2006;. ...
... AURIs can be prevented by practicing physical interventions like regular hand washing, using disposable handkerchiefs, wearing face masks and gargeling 34 . Probiotics (like Lactobacillus spp.), use of herbs and Zinc are also found to be fruitful preventions [35][36][37][38] . ...
Acute respiratory infections (ARIs) are mostly infections of the upper respiratory tract which consists upper airways. Common Acute Upper Respiratory Infections (AURIs) are common cold, acute inflammation of upper respiratory tract i.e., larynx, pharynx, mucus membranes, sinuses and middle ear. Most common bacteria are Streptococcus spp., Haemophillus spp. and Staphylococcus spp. etc. While, Parainfluenza virus, Rhinovirus, Coxsackievirus, Coronavirus, Respiratory Syncytial, Adenovirus and Influenza virus are the common AURIs causing viruses. They are leading cause of mortality and morbidity worldwide with 1.9 million deaths of children annually. In Pakistan, estimated 20-30% of the total childhood deaths >5 is caused by ARIs. The current study analyzed the epidemiology of ARIs in different facility types between Jan 2017- Dec 2019 of District Abbottabad. During the 3 years study period, 4,66,048 cases were reported with Primary health facilities having highest proportion of ARIs and prevalence was highest during 2018 (84.46%). Moreover, Highest (35%) frequency of ARIs occurred during winter with peak in December (12%). While, Tehsil Abbottabad showed high prevalence (68%) as compared to Havelian (32%). This fluctuation may be due to Risk factors that might be low humidity, indoor crowding, illiteracy and low-socioeconomic status. The current findings may help the government in making infrastructure for the health-care system development in future. Keywords: Acute respiratory infections (ARIs), Common Acute Upper Respiratory Infections (AURIs), Bacterial and Viral Etiology, Northern Pakistan
... However, zinc appears to inhibit the activity of RNA polymerase from influenza virus and leads to a decreased viral titer [112]. In addition, zinc supplementation was shown to reduce the frequency and duration of common cold symptoms [111,113,114]. Moreover, zinc supplements induced apoptosis and enhanced the anti-tumor efficacy of cisplatin and paclitaxel in NSCLC by inhibiting the NF-κB signaling pathway and reducing or reversing drug resistance [83,92]. ...
Respiratory diseases remain a major cause of morbidity and mortality worldwide. An imbalance of zinc, an essential trace element, is associated with a variety of lung diseases. We reviewed and summarized recent research (human subjects, animal studies, in vitro studies) on zinc in respiratory diseases to explore the protective mechanism of zinc from the perspective of regulation of oxidative stress, inflammation, lipid metabolism, and apoptosis. In the lungs, zinc has anti-inflammatory, antioxidant, and antiviral effects; can inhibit cancer cell migration; can regulate lipid metabolism and immune cells; and exerts other protective effects. Our comprehensive evaluation highlights the clinical and experimental effects of zinc in the pathogenesis of respiratory diseases. Our analysis also provides insight into the clinical application of zinc-targeted therapy for respiratory diseases.
... COVID patients with low zinc levels showed higher complication rates, with prolonged hospital stays and increased mortality, with an odds ratio of 5.54 [107]. Based on this consideration, studies suggested zinc supplementation in the case of viral infections, finding a prophylactic effect and a reduced length of symptoms [108][109][110]. ...
The recent outbreak of the novel Coronavirus (SARS-CoV-2 or CoV-2) pandemic in 2019 and the risk of CoV-2 infection during pregnancy led the scientific community to investigate the potential negative effects of Coronavirus infection on pregnancy outcomes and fetal development. In particular, as CoV-2 neurotropism has been demonstrated in adults, recent studies suggested a possible risk of fetal brain damage and fetal brain development impairment, with consequent psychiatric manifestations in offspring of mothers affected by COronaVIrus Disease (COVID) during pregnancy. Through the understanding of CoV-2’s pathogenesis and the pathways responsible for cell damage, along with the available data about neurotropic virus attitudes, different strategies have been suggested to lower the risk of neurologic disease in newborns. In this regard, the role of nutrition in mitigating fetal damages related to oxidative stress and the inflammatory environment during viral infection has been investigated, and arginine, n3PUFA, vitamins B1 and B9, choline, and flavonoids were found to be promising in and out of pregnancy. The aim of this review is to provide an overview of the current knowledge on the mechanism of fetal brain damage and the impact of nutrition in reducing inflammation related to worse neurological outcomes in the context of CoV-2 infections during pregnancy.
... Zinc acts as an important immunomodulator, as it regulates the proliferation, differentiation, maturation, and function of leukocytes and lymphocytes, and it also modulates the inflammatory response. In addition, zinc supplementation in adults and children has a beneficial effect to reducing virus-induced symptoms and illness time, such as colds and flu (24,25) . ...
Zinc deficiency compromises its biological functions, its effect on the immune system and its antiviral activity, increasing vulnerability to infectious diseases. This narrative review aims at presenting and discussing functional aspects and possible mechanisms involved in the potential role of zinc in the immune response and antiviral activity for COVID-19 prevention and control. The searches were conducted in PubMed and Science Direct databases, using clinical trials, experimental studies in animals and humans, case-control studies, case series, letters to the editor, and review articles published in English, without restrictions on year of publication. Search approach was based on using the terms: “zinc”, “COVID-19”, “antiviral agents”, “immunologic factors”, and “respiratory tract infections”. Literature shows the importance of zinc as an essential mineral immunomodulator with relevant antiviral activity in the body. Thus, although there is still a scarcity of studies evaluating zinc supplementation in patients with COVID-19, the results on the topic show the necessity of controlling zinc mineral deficiency, as well as maintaining its homeostasis in the body in order to strengthen the immune system and improve the prevention of highly-complex viral infections, such as that of the COVID-19.
... Kaplan-Meier analysis at episode level was performed to compare the episode duration and using Wilcoxon rank-sum test (time until patients were free of symptoms) between dosing groups. The end of an episode was defined as the day from which on all symptoms were rated "absent" (0) or "mild" (1) without re-increase over at least 4 days according to Kurugöl et al. [24]. When episodes had not ended until day 10, duration was censored at day 10 and the patient was considered a non-responder. ...
Background: Due to the frequency and severity of cold symptoms in children, and the risk of associated complications, effective treatments are urgently needed. Here we evaluated the safety profile and treatment benefits of Echinacea in children with acute cold and flu symptoms. Methods: A total of 79 children (4–12 years) were randomized to a treatment regimen of three or five times daily Echinaforce Junior tablets (total of 1200 or 2000 mg Echinacea extract, EFJ) for the prospective treatment of upcoming cold and flu episodes at first signs. Parents recorded respiratory symptoms daily during episodes in their child and physicians and parents subjectively rated tolerability. Results: EFJ was used to treat 130 cold episodes in 68 children and was very well tolerated by more than 96% positive physician’s ratings. EFJ-treated cold episodes lasted 7.5 days on average, with nine out of 10 episodes being fully resolved after 10 days. Five EFJ tablets daily reduced the average episode duration by up to 1.7 days (p < 0.02) in comparison to three EFJ tablets daily regimen. Effective symptom resolution finally contributed to a low antibiotic prescription rate in this study of 4.6%. Conclusions: EFJ tablets present a valuable option for the treatment of acute cold episodes in children showing a wide safety margin and increased therapeutic benefits at five tablets daily.
... ZOTEN were also shown to possess adjuvant-like properties and enhance both T and B cell-mediated immunity in mice (Antoine et al., 2016). In the case of rhinovirus-induced common cold, multiple clinical trials reported a reduction in disease duration and severity in patients taking zinc supplementation (Eby et al., 1984;Hulisz, 2004;Kurugöl et al., 2006). On the mechanistic ...
Hepatitis E virus (HEV) is a major cause of viral hepatitis worldwide. Owing to its feco oral transmission route, sporadic as well as epidemic outbreaks recurrently occur. No specific antiviral therapy is available against the disease caused by HEV. Broad spectrum antivirals such as ribavirin and interferon alfa are prescribed in severe and chronic HEV cases. However, the side effects, cost, and limitations of usage render the available treatment unsuitable for several categories of patients. We recently reported the ability of zinc to inhibit viral replication in mammalian cell culture models of HEV infection. Zinc will be a safe and economical antiviral therapy option if it inhibits HEV replication during the natural course of infection. This essay discusses the putative mechanism(s) by which zinc inhibits HEV replication and provides an overview of the possible therapeutic potential of zinc in HEV patients.
... Common cold more than 12 different studies, analyzing the therapeutic effects of zinc variable results, reduced duration of symptoms if administered within 24 h of onset [107] zinc sulfate 15 mg daily 7 months 100 (Z) 100 (P) lower mean number of colds demonstrating the prophylactic effect of zinc [108] HIV/AIDS Not specified 12 mg for women and 15 mg for men/day 18 months 115 (Z) 116 (P) no effect on viral load. four-fold reduction in the likelihood of immunological failure. ...
Micronutrient homeostasis is a key factor in maintaining a healthy immune system. Zinc is an essential micronutrient that is involved in the regulation of the innate and adaptive immune responses. The main cause of zinc deficiency is malnutrition. Zinc deficiency leads to cell-mediated immune dysfunctions among other manifestations. Consequently, such dysfunctions lead to a worse outcome in the response towards bacterial infection and sepsis. For instance, zinc is an essential component of the pathogen-eliminating signal transduction pathways leading to neutrophil extracellular traps (NET) formation, as well as inducing cell-mediated immunity over humoral immunity by regulating specific factors of differentiation. Additionally, zinc deficiency plays a role in inflammation, mainly elevating inflammatory response as well as damage to host tissue. Zinc is involved in the modulation of the proinflammatory response by targeting Nuclear Factor Kappa B (NF-κB), a transcription factor that is the master regulator of proinflammatory responses. It is also involved in controlling oxidative stress and regulating inflammatory cytokines. Zinc plays an intricate function during an immune response and its homeostasis is critical for sustaining proper immune function. This review will summarize the latest findings concerning the role of this micronutrient during the course of infections and inflammatory response and how the immune system modulates zinc depending on different stimuli.
... [6][7][8] Further, supplement intake of vitamin E has been found to increase mortality. 24 Zinc supplementation and URTI has been studied in several trials where two studies showed a decreased incidence among children 25,26 and five studies showed a reduction in duration among adults. 11 Nevertheless, high zinc levels may act pro-oxidative, 27 and routine supplementation has shown adverse effects on the immune system. ...
Background/objectives:
Antioxidants and polyunsaturated fatty acids (PUFAs) have a role in the human immune defense and may affect the susceptibility to upper respiratory tract infection (URTI). To examine dietary intake of vitamin C, vitamin E, selenium, zinc and PUFAs in relation to URTI incidence in a prospective cohort study.
Subjects/methods:
A total of 1533 Swedish women and men aged 25-64 years were followed for nine months during 2011-2012. Information on dietary intake was assessed through a web-based food frequency questionnaire, and events of URTI were self-reported prospectively as they occurred. Cox proportional hazards regression was applied to obtain incidence rate ratios with 95% confidence intervals.
Results:
The mean number of URTI events was 0.9 among all participants, 1.0 among women and 0.7 among men. In women, the incidence rate ratios (95% confidence interval) for high compared with low intake were 0.69 (0.55-0.88) for vitamin C, 0.77 (0.62-0.96) for vitamin E, 0.57 (0.39-0.83) for docosahexaenoic acid (DHA) and 0.80 (0.65-0.99) for arachidonic acid (AA). No association was found for selenium or zinc among women. In men, an increased URTI incidence was seen with medium vitamin E intake (1.42 (1.09-1.85)) and high zinc intake (1.50 (1.04-2.16)). No association was found for vitamin C, selenium or PUFAs among men.
Conclusions:
We found an inverse association of URTI incidence among women for vitamin C, vitamin E, DHA and AA intake and a positive association among men for vitamin E and zinc intake. The observed gender differences warrant further investigation.European Journal of Clinical Nutrition advance online publication, 11 January 2017; doi:10.1038/ejcn.2016.261.
... Alternative medications, such as Echinacea angustifolia or zinc lozenges, have been tested in several volunteer trials but are not currently thought to be clinically effective. [184][185][186][187] All of these studies suffer from inadequate control groups or incomplete virologic evaluation. ...
Human rhinovirus (HRV) and coronavirus (HCoV) infections are associated with both upper respiratory tract illness ("the common cold") and lower respiratory tract illness (pneumonia). New species of HRVs and HCoVs have been diagnosed in the past decade. More sensitive diagnostic tests such as reverse transcription-polymerase chain reaction have expanded our understanding of the role these viruses play in both immunocompetent and immunosuppressed hosts. Recent identification of severe acute respiratory syndrome and Middle East respiratory syndrome viruses causing serious respiratory illnesses has led to renewed efforts for vaccine development. The role these viruses play in patients with chronic lung disease such as asthma makes the search for antiviral agents of increased importance.
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... They also found significant differences in the mean cold-related school absence, shorter mean duration of cold symptoms, and decreased total severity scores for cold symptoms, favouring the zinctreated group. 18 Likewise, Vakili et al., in a randomised double-blind, placebo-controlled trial, determined whether supplementation of 10 mg of zinc could reduce frequency rate and duration of cold during cold season 200 school aged children living in a low socioeconomic region. They found a significant decrease in common cold incidence among the zinc-supplemented group compared to the placebo group. ...
Background:
Among the preventive strategies for lowering the incidence of upper respiratory tract infections (URTI) and acute diarrhoea episodes, two of the most common diseases in children, zinc supplementation has received special interest. However, there is a need for additional studies that determine the preventive effects of different doses of zinc on URTI and diarrhoeal disease episodes in children.
Methods:
In a randomised, triple-blind clinical trial, we evaluated the efficacy of 12 months of daily zinc supplementation in the incidence of URTI and acute diarrhoea in a population of healthy children aged between 6 and 12 months living in Bogota, Colombia. The outcomes analysed were incidence of URTI, acute diarrhoeal disease episodes, and side effects of the interventions.
Results:
Between 2010 and 2013, a total of 355 children underwent randomisation, with 174 assigned to the zinc supplementation group and 181 to the control group. In the multivariate analyses, having been randomised to the non-supplemented control group (IRR 1.73, 95% CI 1.52-1.97, p<0.001), and nursery attendance (IRR 1.41, 95% CI 1.07-1.87, p=0.016) were independently linked to the number of URTI. Likewise, having been randomised to the non-supplemented group (IRR 1.43, 95% CI 1.20-1.71, p<0.001), and lower socioeconomic status (IRR 1.86, 95% CI 1.11-3.13, p=0.018) were independently associated to the number of diarrhoeal disease episodes.
Conclusions:
Daily supplementation of 5mg of zinc during 12 months significantly decreased the incidence of URTI and diarrhoeal disease episodes in a healthy population of children aged between 6 and 12 months.
... Zinc: Zinc not only modulates cell-mediated immunity, but is also an antioxidant, anti-inflammatory agent decreasing incidence of infections and oxidative stress (51). In a study involving 200 children, zinc sulphate has been found to be effective for the prevention and treatment of common cold in children (52). In another study, when initiated in first 24 hours, zinc had been found to be associated with shorter duration of common cold in healthy individuals with common cold (53). ...
Background:
The common cold is an acute, self-limiting viral respiratory illness. Symptoms include nasal congestion and mucus discharge, sneezing, sore throat, cough, and general malaise. Given the frequency of colds, they are a public health burden and a significant cause of lost work productivity and school absenteeism. There are no established interventions to prevent colds or shorten their duration. However, zinc supplements are commonly recommended and taken for this purpose.
Objectives:
To assess the effectiveness and safety of zinc for the prevention and treatment of the common cold.
Search methods:
We searched CENTRAL, MEDLINE, Embase, CINAHL, and LILACS to 22 May 2023, and searched Web of Science Core Collection and two trials registries to 14 June 2023. We also used reference checking, citation searching, and contact with study authors to identify additional studies.
Selection criteria:
We included randomised controlled trials (RCTs) in children or adults that tested any form of zinc against placebo to prevent or treat the common cold or upper respiratory infection (URTI). We excluded zinc interventions in which zinc was combined with other minerals, vitamins, or herbs (e.g. a multivitamin, or mineral supplement containing zinc).
Data collection and analysis:
We used the Cochrane risk of bias tool to assess risks of bias, and GRADE to assess the certainty of the evidence. We independently extracted data. When necessary, we contacted study authors for additional information. We assessed zinc (type and route) with placebo in the prevention and treatment of the common cold. Primary outcomes included the proportion of participants developing colds (for analyses of prevention trials only), duration of cold (measured in days from start to resolution of the cold), adverse events potentially due to zinc supplements (e.g. unpleasant taste, loss of smell, vomiting, stomach cramps, and diarrhoea), and adverse events considered to be potential complications of the common cold (e.g. respiratory bacterial infections).
Main results:
We included 34 studies (15 prevention, 19 treatment) involving 8526 participants. Twenty-two studies were conducted on adults and 12 studies were conducted on children. Most trials were conducted in the USA (n = 18), followed by India, Indonesia, Iran, and Turkey (two studies each), and Australia, Burkina Faso, Colombia, Denmark, Finland, Tanzania, Thailand, and the UK (one study each). The 15 prevention studies identified the condition as either common cold (n = 8) or URTI (n = 7). However, almost all therapeutic studies (17/19) focused on the common cold. Most studies (17/34) evaluated the effectiveness of zinc administered as lozenges (3 prevention; 14 treatment) in acetate, gluconate, and orotate forms; gluconate lozenges were the most common (9/17). Zinc gluconate was given at doses between 45 and 276 mg/day for between 4.5 and 21 days. Five (5/17) lozenge studies gave acetate lozenges and two (2/17) gave both acetate and gluconate lozenges. One (1/17) lozenge study administered intranasal (gluconate) and lozenge (orotate) zinc in tandem for cold treatment. Of the 17/34 studies that did not use lozenges, 1/17 gave capsules, 3/17 administered dissolved powders, 5/17 gave tablets, 4/17 used syrups, and 4/17 used intranasal administration. Most studies were at unclear or high risk of bias in at least one domain. There may be little or no reduction in the risk of developing a cold with zinc compared to placebo (risk ratio (RR) 0.93, 95% CI 0.85 to 1.01; I2 = 20%; 9 studies, 1449 participants; low-certainty evidence). There may be little or no reduction in the mean number of colds that occur over five to 18 months of follow-up (mean difference (MD) -0.90, 95% CI -1.93 to 0.12; I2 = 96%; 2 studies, 1284 participants; low-certainty evidence). When colds occur, there is probably little or no difference in the duration of colds in days (MD -0.63, 95% CI -1.29 to 0.04; I² = 77%; 3 studies, 740 participants; moderate-certainty evidence), and there may be little or no difference in global symptom severity (standardised mean difference (SMD) 0.04, 95% CI -0.35 to 0.43; I² = 0%; 2 studies, 101 participants; low-certainty evidence). When zinc is used for cold treatment, there may be a reduction in the mean duration of the cold in days (MD -2.37, 95% CI -4.21 to -0.53; I² = 97%; 8 studies, 972 participants; low-certainty evidence), although it is uncertain whether there is a reduction in the risk of having an ongoing cold at the end of follow-up (RR 0.52, 95% CI 0.21 to 1.27; I² = 65%; 5 studies, 357 participants; very low-certainty evidence), or global symptom severity (SMD -0.03, 95% CI -0.56 to 0.50; I² = 78%; 2 studies, 261 participants; very low-certainty evidence), and there may be little or no difference in the risk of a change in global symptom severity (RR 1.02, 95% CI 0.85 to 1.23; 1 study, 114 participants; low-certainty evidence). Thirty-one studies reported non-serious adverse events (2422 participants). It is uncertain whether there is a difference in the risk of adverse events with zinc used for cold prevention (RR 1.11, 95% CI 0.84 to 1.47; I2 = 0%; 7 studies, 1517 participants; very low-certainty evidence) or an increase in the risk of serious adverse events (RR 1.67, 95% CI 0.78 to 3.57; I2 = 0%; 3 studies, 1563 participants; low-certainty evidence). There is probably an increase in the risk of non-serious adverse events when zinc is used for cold treatment (RR 1.34, 95% CI 1.15 to 1.55; I2 = 44%; 2084 participants, 16 studies; moderate-certainty evidence); no treatment study provided information on serious adverse events. No study provided clear information about adverse events considered to be potential complications of the common cold.
Authors' conclusions:
The findings suggest that zinc supplementation may have little or no effect on the prevention of colds but may reduce the duration of ongoing colds, with an increase in non-serious adverse events. Overall, there was wide variation in interventions (including concomitant therapy) and outcomes across the studies, as well as incomplete reporting of several domains, which should be considered when making conclusions about the efficacy of zinc for the common cold.
Die Rolle von Mikronährstoffen wie Vitamin C, Vitamin D oder Zink in der Prävention und Therapie von Erkältungskrankheiten wird seit Langem diskutiert. Die Evidenzlage hierzu ist gemischt, was der Heterogenität der Studienpopulationen, dem oftmals fehlenden Erregernachweis sowie der unterschiedlichen Dauer, Frequenz und Dosis der Mikronährstoffgabe geschuldet ist. Festgehalten werden kann, dass es sinnvoll ist, die Supplementation individuell an den Ernährungsstatus, an Grunderkrankungen und Laborparameter anzupassen. Ein Vitamin-D-Mangel sollte ausgeglichen werden. Von einer Vitamin-C-Supplementation profitieren insbesondere Personen, die unter hohem körperlichen Stress stehen, sowie jene mit Exposition gegenüber Menschen mit akuten Atemwegsinfektionen.
Background:
Zinc deficiency is prevalent in low- and middle-income countries, and is considered a significant risk factor for morbidity, mortality, and linear growth failure. The effectiveness of preventive zinc supplementation in reducing prevalence of zinc deficiency needs to be assessed.
Objectives:
To assess the effects of zinc supplementation for preventing mortality and morbidity, and for promoting growth, in children aged 6 months to 12 years.
Search methods:
A previous version of this review was published in 2014. In this update, we searched CENTRAL, MEDLINE, Embase, five other databases, and one trials register up to February 2022, together with reference checking and contact with study authors to identify additional studies.
Selection criteria:
Randomized controlled trials (RCTs) of preventive zinc supplementation in children aged 6 months to 12 years compared with no intervention, a placebo, or a waiting list control. We excluded hospitalized children and children with chronic diseases or conditions. We excluded food fortification or intake, sprinkles, and therapeutic interventions.
Data collection and analysis:
Two review authors screened studies, extracted data, and assessed the risk of bias. We contacted study authors for missing information and used GRADE to assess the certainty of evidence. The primary outcomes of this review were all-cause mortality; and cause-specific mortality, due to all-cause diarrhea, lower respiratory tract infection (LRTI, including pneumonia), and malaria. We also collected information on a number of secondary outcomes, such as those related to diarrhea and LRTI morbidity, growth outcomes and serum levels of micronutrients, and adverse events.
Main results:
We included 16 new studies in this review, resulting in a total of 96 RCTs with 219,584 eligible participants. The included studies were conducted in 34 countries; 87 of them in low- or middle-income countries. Most of the children included in this review were under five years of age. The intervention was delivered most commonly in the form of syrup as zinc sulfate, and the most common dose was between 10 mg and 15 mg daily. The median duration of follow-up was 26 weeks. We did not consider that the evidence for the key analyses of morbidity and mortality outcomes was affected by risk of bias. High-certainty evidence showed little to no difference in all-cause mortality with preventive zinc supplementation compared to no zinc (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.84 to 1.03; 16 studies, 17 comparisons, 143,474 participants). Moderate-certainty evidence showed that preventive zinc supplementation compared to no zinc likely results in little to no difference in mortality due to all-cause diarrhea (RR 0.95, 95% CI 0.69 to 1.31; 4 studies, 132,321 participants); but probably reduces mortality due to LRTI (RR 0.86, 95% CI 0.64 to 1.15; 3 studies, 132,063 participants) and mortality due to malaria (RR 0.90, 95% CI 0.77 to 1.06; 2 studies, 42,818 participants); however, the confidence intervals around the summary estimates for these outcomes were wide, and we could not rule out a possibility of increased risk of mortality. Preventive zinc supplementation likely reduces the incidence of all-cause diarrhea (RR 0.91, 95% CI 0.90 to 0.93; 39 studies, 19,468 participants; moderate-certainty evidence) but results in little to no difference in morbidity due to LRTI (RR 1.01, 95% CI 0.95 to 1.08; 19 studies, 10,555 participants; high-certainty evidence) compared to no zinc. There was moderate-certainty evidence that preventive zinc supplementation likely leads to a slight increase in height (standardized mean difference (SMD) 0.12, 95% CI 0.09 to 0.14; 74 studies, 20,720 participants). Zinc supplementation was associated with an increase in the number of participants with at least one vomiting episode (RR 1.29, 95% CI 1.14 to 1.46; 5 studies, 35,192 participants; high-certainty evidence). We report a number of other outcomes, including the effect of zinc supplementation on weight and serum markers such as zinc, hemoglobin, iron, copper, etc. We also performed a number of subgroup analyses and there was a consistent finding for a number of outcomes that co-supplementation of zinc with iron decreased the beneficial effect of zinc.
Authors' conclusions:
Even though we included 16 new studies in this update, the overall conclusions of the review remain unchanged. Zinc supplementation might help prevent episodes of diarrhea and improve growth slightly, particularly in children aged 6 months to 12 years of age. The benefits of preventive zinc supplementation may outweigh the harms in regions where the risk of zinc deficiency is relatively high.
Introduction: Common cold is a viral infection of upper respiratory tract, caused by over 200 strains of viruses, mainly rhinoviruses, coronaviruses, adenoviruses and rotaviruses. The common cold is the most frequent infection among the human population and is responsible for up to 20% of all medical visits in developed countries. Despite this fact, no vaccine nor cure currrently exists. In recent years a number of studies have been published, describing effects of zinc supplementation on reduction of a duration of a common cold. Aim of the study: A summary of the current state of knowledge, treatment efficacy and future possibilities regarding the use of zinc during the common cold. Methods and materials: A review of the available literature on PubMed database, using keywords: „common cold”, „zinc supplementation”, „viral infection” Results: Usage of zinc in appropriate dose during common cold leads to shortening the duration of an infection, as well as reducing severity of symptoms. Zinc supplementation has also a documented effect on decresing risk of viral infection. Conculusions: Common cold, while being the most frequent viral infection among human population in developed world, leads to serious socioeconomic consequences. Therefore any aid in shortening the duration of this illness is much needed. Since zinc supplements have a documented positive effect on the speed of healing during acute viral infections and do not carry a significant number of side effects, they can be successfully used to treat the common cold.
During the last few decades, the micronutrient zinc has proven to be an important metal ion for a well-functioning immune system, and thus also for a suitable immune defense. Nowadays, it is known that the main cause of zinc deficiency is malnutrition. In particular, vulnerable populations, such as the elderly in Western countries and children in developing countries, are often affected. However, sufficient zinc intake and homeostasis is essential for a healthy life, as it is known that zinc deficiency is associated with a multitude of immune disorders such as metabolic and chronic diseases, as well as infectious diseases such as respiratory infections, malaria, HIV, or tuberculosis. Moreover, the modulation of the proinflammatory immune response and oxidative stress is well described. The anti-inflammatory and antioxidant properties of zinc have been known for a long time, but are not comprehensively researched and understood yet. Therefore, this review highlights the current molecular mechanisms underlying the development of a pro-/ and anti-inflammatory immune response as a result of zinc deficiency and zinc supplementation. Additionally, we emphasize the potential of zinc as a preventive and therapeutic agent, alone or in combination with other strategies, that could ameliorate infectious diseases.
Zinc supplementation reduces morbidity, but evidence suggests that excessive intakes may have negative health consequences. Current guidelines of upper limits (ULs) of zinc intake for young children are extrapolated from adult data. This systematic review (PROSPERO; registration no. CRD42020215187) aimed to determine the levels of zinc intake at which adverse effects are observed in young children. Studies reporting potential adverse effects of zinc intake in children aged 0–3 years were identified (from inception to August 2020) in MEDLINE, EMBASE and the Cochrane Library, with no limits on study design. Adverse clinical and physical effects of zinc intake were synthesized narratively, and meta-analyses of biochemical outcomes were conducted. Random effects models, forest plots were generated to examine the evidence by age category, dose, dose duration, chemical formula of zinc, and zinc vs placebo. The Joanna Briggs Institute Critical Appraisal Checklist, Cochrane Risk of Bias 2, and Grading of Recommendations Assessment, Development and Evaluation guideline (GRADE) were employed to assess risk of bias and to appraise the certainty of evidence. Fifty-eight studies assessed possible adverse effects of zinc doses ranging from 3 to 70 mg/d. Data from 39 studies contributed to meta-analyses. Zinc supplementation had an adverse effect on serum ferritin, plasma/serum copper concentration, sTfR, hemoglobin, hematocrit, and the odds of anemia in at least one of the subgroups investigated. Lactulose: mannitol ratio was improved with zinc supplementation, and no significant effect was observed on CRP, eSOD, ZPP and blood cholesterol and iron deficiency anemia. The certainty of the evidence, as assessed using GRADE, was very low to moderate. Although possible adverse effects of zinc supplementation were observed in some subgroups, it is unclear whether these findings are clinically important. The synthesized data can be used to undertake a dose-response analysis to update current guidelines of ULs of zinc intake for young children.
Upper respiratory tract infections (URTIs), otitis media, and tonsillopharyngitis are the most common pediatric otolaryngological infections during childhood. URTIs refer to any infectious diseases involving the nose, sinuses, pharynx, or larynx and they are usually caused by viral agents. Although these infections are mostly caused by viruses, diseases that last more than 7–10 days generally refer to secondary bacterial infections. Whether caused by viral or bacterial agents, pediatric otolaryngological infections constitute one of the most common reasons for doctor visits and cause considerable socioeconomic burden for the community.
It remains uncertain as to whether nutrient supplementation for the general population considered healthy could be useful in the prevention of RTIs, such as COVID‐19. In this systematic review and meta‐analysis, the evidence was evaluated for primary prevention of any viral respiratory tract infection (RTI) such as SARS‐CoV‐2, through supplementation of nutrients with a recognized role in immune function: multiple micronutrients, vitamin A, folic acid, vitamin B12, C, D, E, beta‐carotene, zinc, iron and long‐chain polyunsaturated fatty acids. The search produced 15,163 records of which 93 papers (based on 115 studies) met the inclusion criteria, resulting in 199,055 subjects (191,636 children and 7,419 adults) from 37 countries. Sixty‐three studies were included in the meta‐analyses, which was performed for children and adults separately. By stratifying the meta‐analysis by world regions, only studies performed in Asia showed a significant but heterogeneous protective effect of zinc supplementation on RTIs (RR 0.86, 95% CI 0.7–0.96, I² = 79.1%, p = .000). Vitamin D supplementation in adults significantly decreased the incidence of RTI (RR 0.89, 95% CI 0.79–0.99, p = .272), particularly in North America (RR 0.82 95% CI 0.68–0.97), but not in Europe or Oceania. Supplementation of nutrients in the general population has either no or at most a very limited effect on prevention of RTIs. Zinc supplementation appears protective for children in Asia, whilst vitamin D may protect adults in the USA and Canada. In 10/115 (8.7%) studies post‐hoc analyses based on stratification for nutritional status was performed. In only one study zinc supplementation was found to be more effective in children with low zinc serum as compared to children with normal zinc serum levels.
Zinc is an indispensable trace element required for several critical functions of the human body. Deficiencies of micronutrients can impair immune function and increase susceptibility to infectious disease. It is noteworthy that higher susceptibility to the SARS-CoV-2 viral infection is seen in individuals with micronutrient deficiencies and poorer overall nutrition. Research in the last two decades suggests that one-third of the global population may be deficient in zinc, which affects the health and well-being of individuals of all ages and gender. Zinc deficiency is now considered one of the factors associated with susceptibility to infection and the detrimental progression of COVID-19. The trace element is essential for immunocompetence and antiviral activity, rendering zinc supplements highly popular and widely consumed. Zinc supplements are required in small doses daily, and their absorption is affected by food rich in fiber and phytase. The organic forms of zinc such as picolinate, citrate, acetate, gluconate, and the monomethionine complexes are better absorbed and have biological effects at lower doses than inorganic salts. Considering the present global scenario, choosing the right zinc supplement is essential for maintaining good health. In the present review, we reexamine the role of zinc in immunity and antiviral activity and a comparative account of different forms of zinc supplements.
The importance of balanced dietary habits, which include appropriate amounts of antioxidants to maintain the immune system, has become increasingly relevant during the current SARS-CoV-2/COVID-19 pandemic, because viral infections are characterized by high oxidative stress. Furthermore, the measures taken by governments to control the pandemic have led to increased anxiety, stress, and depression, which affect physical and mental health, all of which are influenced by nutritional status, diet, and lifestyle. The Mediterranean diet (MD), Atlantic diet (AD), and the Dietary Guidelines for Americans all provide the essential vitamins, minerals, and phenolic compounds needed to activate enzymatic and nonenzymatic antioxidant responses. However, viral pandemics such as the current COVID-19 crisis entail high oxidative damage caused by both the infection and the resultant social stresses within populations, which increases the probability and severity of infection. Balanced dietary patterns such as the MD and the AD are characterized by the consumption of fruit, vegetables, legumes, olive oil, and whole grains with low intakes of processed foods and red meat. For a healthy lifestyle in young adults, the MD in particular provides the required amount of antioxidants per day for vitamins D (0.3–3.8 μg), E (17.0 mg), C (137.2–269.8 mg), A (1273.3 μg), B-12 (1.5–2.0 μg), and folate (455.1–561.3 μg), the minerals Se (120.0 μg), Zn (11.0 mg), Fe (15.0–18.8 mg), and Mn (5.2–12.5 mg), and polyphenols (1171.00 mg) needed to maintain an active immune response. However, all of these diets are deficient in the recommended amount of vitamin D (20 μg/d). Therefore, vulnerable populations such as elders and obese individuals could benefit from antioxidant supplementation to improve their antioxidant response. Although evidence remains scarce, there is some indication that a healthy diet, along with supplemental antioxidant intake, is beneficial to COVID-19 patients.
The world is currently facing the coronavirus disease (COVID-19) pandemic which places great pressure on health care systems and workers, often presents with severe clinical features, and sometimes requires admission into intensive care units. Derangements in nutritional status, both for obesity and malnutrition, are relevant for the clinical outcome in acute illness. Systemic inflammation, immune system impairment, sarcopenia, and preexisting associated conditions, such as respiratory, cardiovascular, and metabolic diseases related to obesity, could act as crucial factors linking nutritional status and the course and outcome of COVID-19. Nevertheless, vitamins and trace elements play an essential role in modulating immune response and inflammatory status. Overall, evaluation of the patient's nutritional status is not negligible for its implications on susceptibility, course, severity, and responsiveness to therapies, in order to perform a tailored nutritional intervention as an integral part of the treatment of patients with COVID-19. The aim of this study was to review the current data on the relevance of nutritional status, including trace elements and vitamin status, in influencing the course and outcome of the disease 3 mo after the World Health Organization's declaration of COVID-19 as a pandemic.
Micronutrient homeostasis is a key factor in maintaining a healthy immune system. Zinc is an essential micronutrient that is involved in the regulation of the innate and adaptive immune responses. The main cause of zinc deficiency is malnutrition. Zinc deficiency leads to cell-mediated immune dysfunctions among other manifestations. Consequently, such dysfunctions lead to a worse outcome in the response towards bacterial infection and sepsis. For instance, zinc is an essential component of the pathogen-eliminating signal transduction pathways leading to neutrophil extracellular traps formation, as well as inducing cell-mediated immunity over humoral immunity by regulating specific factors or differentiation. Additionally, zinc deficiency plays a role in inflammation, mainly elevating inflammatory response as well as damage to host tissue. Zinc is involved in the modulation of the proinflammatory response by targeting Nuclear Factor Kappa B, a transcription factor that is the master regulator of proinflammatory responses. It is also involved in controlling oxidative stress and regulating inflammatory cytokines. Zinc plays an intricate function during an immune response and its homeostasis is critical for sustaining proper immune function. This review will summarize the latest findings concerning the role of this micronutrient during the course of infections and inflammatory response and how the immune system modulates zinc depending on different stimuli.
During the current corona pandemic, new therapeutic options against this viral disease are urgently desired. Due to the rapid spread and immense number of affected individuals worldwide, cost-effective, globally available, and safe options with minimal side effects and simple application are extremely warranted. This review will therefore discuss the potential of zinc as preventive and therapeutic agent alone or in combination with other strategies, as zinc meets all the above described criteria. While a variety of data on the association of the individual zinc status with viral and respiratory tract infections are available, study evidence regarding COVID-19 is so far missing but can be assumed as was indicated by others and is detailed in this perspective, focusing on re-balancing of the immune response by zinc supplementation. Especially, the role of zinc in viral-induced vascular complications has barely been discussed, so far. Interestingly, most of the risk groups described for COVID-19 are at the same time groups that were associated with zinc deficiency. As zinc is essential to preserve natural tissue barriers such as the respiratory epithelium, preventing pathogen entry, for a balanced function of the immune system and the redox system, zinc deficiency can probably be added to the factors predisposing individuals to infection and detrimental progression of COVID-19. Finally, due to its direct antiviral properties, it can be assumed that zinc administration is beneficial for most of the population, especially those with suboptimal zinc status.
Because of its high prevalence acute respiratory diseases have a significant impact on the population. The focus of this review was the current state of knowledge for the prophylactic efficacy of: zinc, vitamin C, Echinacea preparations, garlic and carrying out physical measures. Furthermore, the benefits of pneumococcal and influenza vaccine were elicited. In the synopsis, the physical measures proved to be the most effective, cost-effective method to prevent infections. The intake of zinc, Echinacea preparations (for example: E. purpurea), vitamin C and garlic showed moderate success in the prevention of infection and must be elicited individually. Pneumococcal and annual influenza vaccines in family practice should be given furthermore accordingly topical STIKO-recommendation. Nevertheless, the prophylactic effect from influenza vaccines on usual cold illnesses is unsettled.
© Georg Thieme Verlag KG Stuttgart · New York.
Because of its high prevalence acute respiratory diseases have a significant impact on the population. The focus of this review was the current state of knowledge for the prophylactic efficacy of: zinc, vitamin C, Echinacea preparations, garlic and carrying out physical measures. Furthermore, the benefits of pneumococcal and influenza vaccine were elicited. In the synopsis, the physical measures proved to be the most effective, cost-effective method to prevent infections. The intake of zinc, Echinacea preparations (for example: E. purpurea), vitamin C and garlic showed moderate success in the prevention of infection and must be elicited individually. Pneumococcal and annual influenza vaccines in family practice should be given furthermore accordingly topical STIKO-recommendation. Nevertheless, the prophylactic effect from influenza vaccines on usual cold illnesses is unsettled.
Akute respiratorische Erkrankungen (ARE) gehören zu den häufigsten Erkrankungen in den industrialisierten Staaten. Symptome divergieren in Dauer und Intensität. Sie schränken den Patienten in seinem Allgemeinbefinden oft derart ein, dass eine Arbeitsunfähigkeit resultiert. Um für die Patientenberatung eine aktuelle Übersicht zu haben, wurde eine Literaturrecherche zum Thema „Infektprophylaxe“ durchgeführt.
Zinc plays a diverse role in human health. It is an essential trace element for all life forms due to its role in cell proliferation, transcription and enzyme activity. Since the immune system is the organ system with the highest proliferation rate, zinc is crucial for maintaining an intact immune system and affects virtually all of its components. The chapter first gives an overview of zinc nutrition and the role of zinc in human health. The role of zinc in the modulation of cellular processes is discussed on the basis of the altered molecular mechanisms. The influence of zinc on the immune system is reported in more detail. Finally therapeutic uses and future options of zinc supplementation are critically analysed.
Objective
Serum zinc level might be related to pathogenesis of febrile seizure (FS). The purpose of this study was to evaluate efficacy and safety of oral zinc supplementation on FS recurrence prevention in non-zinc-deficient children.
Materials and Methods
In a randomized clinical study, one hundred 18 to 60 mo old children with normal zinc level with first simple FS were referred to Shahid Sadoughi Hospital, Yazd, Iran from May 2012 to June 2013, were randomly assigned to two groups to receive 2 mg/kg/d zinc sulfate for six consecutive months or placebo as control group and were followed up for 1 y for FS recurrence.
Results
41 girls and 59 boys with mean age of 2.47 ± 1.01 y were evaluated. Race, mean weight, height and body fat were similar in both groups. FS recurrence occurred in 19 children (38%) in the control group [95% confidence interval (CI): 19.45%–53.95%] and in 11 children (22%) in the zinc sulfate (95% CI: 57.47%–89.13%) groups, respectively; and the zinc group had lower FS recurrence (P = 0.03). The mean serum zinc level before intervention was lower in children with FS recurrence (72.43 ± 14.58 μg/dL versus 96.33 ± 12.69 μg/dL, P = 0.04).
Gastrointestinal side effects (vomiting in five children, heartburn in two children and abdominal pain in one child) were seen in 16% of the zinc group and vomiting occurred in two children (4%) in control group and frequency of adverse events was similar in the two groups (P = 0.1).
Conclusion
Zinc supplementation should be considered as effective and safe in prevention of FS recurrence.
The common cold is one of the most widespread illnesses and is a leading cause of visits to the doctor and absence from school and work. Trials conducted in high-income countries since 1984 investigating the role of zinc for the common cold symptoms have had mixed results. Inadequate treatment masking and reduced bioavailability of zinc from some formulations have been cited as influencing results.
To assess whether zinc (irrespective of the zinc salt or formulation used) is efficacious in reducing the incidence, severity and duration of common cold symptoms. In addition, we aimed to identify potential sources of heterogeneity in results obtained and to assess their clinical significance.
In this updated review, we searched CENTRAL (2012, Issue 12), MEDLINE (1966 to January week 2, 2013), EMBASE (1974 to January 2013), CINAHL (1981 to January 2013), Web of Science (1985 to January 2013), LILACS (1982 to January 2013), WHO ICTRP and clinicaltrials.gov.
Randomised, double-blind, placebo-controlled trials using zinc for at least five consecutive days to treat, or for at least five months to prevent the common cold.
Two review authors independently extracted data and assessed trial quality.
Five trials were identified in the updated searches in January 2013 and two of them did not meet our inclusion criteria. We included 16 therapeutic trials (1387 participants) and two preventive trials (394 participants). Intake of zinc was associated with a significant reduction in the duration (days) (mean difference (MD) -1.03, 95% confidence interval (CI) -1.72 to -0.34) (P = 0.003) (I(2) statistic = 89%) but not the severity of common cold symptoms (MD -1.06, 95% CI -2.36 to 0.23) (P = 0.11) (I(2) statistic = 84%). The proportion of participants who were symptomatic after seven days of treatment was significantly smaller (odds ratio (OR) 0.45, 95% CI 0.20 to 1.00) (P = 0.05) than those in the control, (I(2 )statistic = 75%). The incidence rate ratio (IRR) of developing a cold (IRR 0.64, 95% CI 0.47 to 0.88) (P = 0.006) (I(2) statistic = 88%), school absence (P = 0.0003) and prescription of antibiotics (P < 0.00001) was lower in the zinc group. Overall adverse events (OR 1.58, 95% CI 1.19 to 2.09) (P = 0.002), bad taste (OR 2.31, 95% CI 1.71 to 3.11) (P < 0.00001) and nausea (OR 2.15, 95% CI 1.44 to 3.23) (P = 0.002) were higher in the zinc group. The very high heterogeneity means that the averaged estimates must be viewed with caution.
Zinc administered within 24 hours of onset of symptoms reduces the duration of common cold symptoms in healthy people but some caution is needed due to the heterogeneity of the data. As the zinc lozenges formulation has been widely studied and there is a significant reduction in the duration of cold at a dose of ≥ 75 mg/day, for those considering using zinc it would be best to use it at this dose throughout the cold. Regarding prophylactic zinc supplementation, currently no firm recommendation can be made because of insufficient data. When using zinc lozenges (not as syrup or tablets) the likely benefit has to be balanced against side effects, notably a bad taste and nausea.
This report of a randomized, double-masked, placebo-controlled clinical study demonstrates the effectiveness of zinc acetate lozenges on common cold symptoms in allergy-tested subjects. Subjects in the zinc and placebo groups were evenly matched with respect to sex, race/ethnicity, allergy test status, and age. Overall symptom duration was significantly less in the zinc group than in the placebo group (mean, 3.8 day vs 5.1 days). The mean severity rating for all symptoms was lower in the zinc group than in the placebo group; this difference, however, was not statistically significant. Allergy-positive subjects who used zinc had a statistically significant shorter duration of nasal symptoms than allergy-negative subjects (3.5 days vs 7.6 days). In conclusion, we propose that zinc acetate lozenges may significantly shorten the duration of common cold symptoms and relieve symptoms associated with allergies
A prior national survey documented the high prevalence and costs of alternative medicine use in the United States in 1990.
To document trends in alternative medicine use in the United States between 1990 and 1997.
Nationally representative random household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997, respectively.
A total of 1539 adults in 1991 and 2055 in 1997.
Prevalence, estimated costs, and disclosure of alternative therapies to physicians.
Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8% in 1990 to 42.1% in 1997 (P < or = .001). The therapies increasing the most included herbal medicine, massage, megavitamins, self-help groups, folk remedies, energy healing, and homeopathy. The probability of users visiting an alternative medicine practitioner increased from 36.3% to 46.3% (P = .002). In both surveys alternative therapies were used most frequently for chronic conditions, including back problems, anxiety, depression, and headaches. There was no significant change in disclosure rates between the 2 survey years; 39.8% of alternative therapies were disclosed to physicians in 1990 vs 38.5% in 1997. The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 (64.0%) and 1997 (58.3%) (P=.36). Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians. An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and/or high-dose vitamins (18.4% of all prescription users). Estimated expenditures for alternative medicine professional services increased 45.2% between 1990 and 1997 and were conservatively estimated at 12.2 billion paid out-of-pocket. This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations. Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27.0 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services.
Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.
A report in 1984 on the success of zinc gluconate against common cold symptoms could not be confirmed in three subsequent studies, which are now known to have used formulations that inactivated zinc. A non-chelating formulation including glycine, which releases 93% of contained zinc into saliva, was tested in a randomized, placebo-controlled, double-blind trial in 73 young adults. Efficacy was recorded in symptom diaries using a symptom severity rating. Patients' symptoms first appeared 1.34 days prior to entry to the study in both groups. Disappearance of symptoms occurred after an additional 4.9 days for zinc-treated patients versus 6.1 days for placebo-treated patients. A difference was noted in the efficacy of treatment if it was started 1 day after symptom onset: cold duration was an additional 4.3 days in zinc-treated patients compared with 9.2 days for placebo-treated patients. Cough, nasal drainage and congestion were the symptoms most affected, and only mild side-effects were noted.
The therapeutic efficacy of zinc gluconate lozenge therapy in experimentally induced rhinovirus infection was assessed in
two randomized controlled trials in susceptible adult volunteers. In trial 1, lozenges containing either zinc gluconate (23
mg of elemental zinc) or placebo were given 36 h after nasal inoculation of rhinovirus type 39 and administered eight times
per day for 5 days. All of the volunteers had early cold symptoms at the time that treatment was begun. In trial 2, the same
lozenge regimen was used, beginning 2 h after nasal inoculation with rhinovirus type 13, and continued for 7 days. Zinc therapy
did not reduce the severity or duration of cold symptoms or the frequency or duration of viral shedding in either trial. Viral
titers were measured in trial 2 and were shown to be unaffected by zinc therapy. Nasal mucus weights and the numbers of paper
tissues used were slightly higher in zinc recipients. A statistically significant increase in levels of zinc in serum was
documented in zinc recipients after 5 days of therapy. These data suggest that zinc gluconate lozenge therapy is not therapeutically
useful in the treatment of rhinovirus colds.
Effervescent lozenges containing 10 mg of zinc acetate were evaluated as a treatment of upper respiratory tract infections
in a double-blind randomized trial by using a placebo which was indistinguishable to most observers in taste and appearance
from the active material. Of the 70 treatment courses used by 55 individuals in 34 families, 63 (33 zinc and 30 placebo) were
considered evaluable, in that the volunteer used the medication at least four times daily for at least 3 days, the average
utilization being 5.4 days at an average dose of six lozenges daily. Six users of zinc reported nausea (versus no placebo
users), and eight reported an unpleasant taste or aftertaste (versus one placebo user). No benefit was observed among the
users of zinc acetate. The mean duration of symptoms in users of the zinc was 12.1 days, compared with 7.7 days in those who
used the placebo. Nor was any beneficial effect of zinc evident among the four zinc-treated versus the two placebo-treated
individuals from whom rhinovirus was grown.
Age- and sex-specific reference intervals based on the 0.025 and 0.975 fractiles of data derived from a healthy pediatric population are presented for zinc, copper, selenium, iron, ferritin, retinol, alpha-tocopherol, and related analytes in serum. Age was an important covariate for copper, selenium, retinol, and tocopherol, and ferritin in boys. Strong correlations were found between retinol and retinol-binding protein, prealbumin (transthyretin), alpha-tocopherol, and selenium. Tocopherol was highly correlated with both cholesterol and triglycerides. We found no relationship between serum zinc and either retinol or retinol-binding protein. Despite exclusion of children in whom anemia, microcytosis, or variant hemoglobins were found, the 0.025 fractile for iron in several age groups was even less than the concentration considered to indicate poor iron nutritional status.
As a possible treatment for common colds, we tested zinc gluconate lozenges in a double-blind, placebo-controlled, clinical
trial. One 23-mg zinc lozenge or matched placebo was dissolved in the mouth every 2 wakeful h after an initial double dose.
After 7 days, 86% of 37 zinc-treated subjects were asymptomatic, compared with only 46% of 28 placebo-treated subjects (P
= 0.0005). Side effects or complaints were usually minor and consisted mainly of objectionable taste and mouth irritation.
Zinc lozenges shortened the average duration of common colds by about 7 days.
In the United States, the common cold has been estimated to cost more than $3.5 billion a year. Despite several randomized clinical trials, the effect of treating colds with zinc salts lozenges remains uncertain because of conflicting results.
To conduct a meta-analysis of published randomized clinical trials on the use of zinc salts lozenges in colds using a random effects model.
Eight clinical trials of treating adults with zinc salts lozenges were identified. After excluding 2 studies that used nasal inoculation of rhinovirus, 6 trials were combined and analyzed. The summary odds ratio for the presence of any cold symptoms at 7 days was 0.50 (95% confidence interval, 0.19-1.29).
Despite numerous randomized trials, the evidence for effectiveness of zinc salts lozenges in reducing the duration of common colds is still lacking.
Effective treatment for the common cold have been difficult to develop because so many different types of virus are responsible for this condition. Oral zinc has been studied as a possible means of preventing or alleviating symptoms, with mixed results. We studied a new approach to zinc therapy--an over-the-counter nasal gel formulation (Zicam)--to independently evaluate its efficacy as a treatment for the common cold. Our study was conducted at four sites over a 5-month period. The study group consisted of 213 patients with recent-onset(< or = 24) cold symptoms; 108 patients received zinc therapy, and 105 reviewed placebo. Symptom charts were used to track the duration and severity of each patient's symptoms. At study's end, the duration of symptoms was 2.3 days (+/-0.9)in the zinc group and 9.0 days (+/-2.5)in the control group--a statistically significant difference (p <0.05). These results provide evidence that zinc nasal gel is effective in shortening the duration of common cold symptoms off when taken within 24 hours of their onset.
The common cold is considered to be caused by viruses and it has long been believed that antibiotics have no role in treating this condition. In many countries doctors will often prescribe antibiotics for the common cold in the belief that they may prevent secondary bacterial infection and in some cases to respond to patient demand. There is also increasing concern over the resistance of common bacteria to commonly used antibiotics. A crucial step in reducing the use of antibiotics for the common cold is to examine the evidence to see if there is any benefit or if there is benefit for some subgroups or symptom constellations.
(1) To determine the efficacy of antibiotics in comparison with placebo in the treatment of acute upper respiratory tract infections (common colds) in terms of the proportion of patients in whom the clinical outcome was considered to be a reduction in general symptoms and specific nasopharyngeal symptoms. (2) To determine whether there are significant adverse outcomes associated with antibiotic therapy for patients with a clinical diagnosis of acute upper respiratory tract infection.
We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, the Family Medicine Database, and reference lists of articles, and we contacted principal investigators. The most recent search was in May 2001
Randomised trials comparing any antibiotic therapy with placebo in acute upper respiratory tract infections with less than 7 days of symptoms
Both reviewers independently assessed trial quality and extracted data.
All analyses used fixed effects unless otherwise stated Main results: Nine trials involving 2249 (2157 analysed) people aged between two months and 79 years (and adults with no upper age limit) years were included. The overall quality of the included trials was variable. People receiving antibiotics did not do better in terms of lack of cure or persistence of symptoms than those on placebo (odds ratio 0.8, 95% confidence interval (95% CI) 0.59 to 1.08). Only one study Taylor et al (1977) specifically reported persistence of clear rhinitis with a small benefit to those on antibiotics. Two studies found a significant benefit for antibiotics compared with placebo for runny nose (clear) odds ratio 0.42 (0.22-0.78). Two studies also found a significant benefit in patients with sore throat odds ratio 0.27 95% CI (0.10-0.74). Only one study reported work time lost with 22% of those on antibiotic treatment and 25% of those on placebo but this was not significant. Adult patients treated with antibiotics had a significant increase in adverse effects (odds ratio 3.6 95% CI 2.21 to 5.89) while there was no significant increase in children odds ratio 0.90 95% CI (0.44-1.82).
Reviewers' conclusions: There is not enough evidence of important benefits from the treatment of upper respiratory tract infections with antibiotics to warrant their routine use in children or adults and there is a significant increase in adverse effects associated with antibiotic use in adult patients.
Common colds were shortened by 7 days in a 1984 clinical trial using zinc gluconate throat lozenges each 2 h. Between then and 2004, 10 other double-blind, placebo-controlled clinical trials showed widely varying results. This re-analysis of these trials presents solution chemistry methods to elucidate differences in efficacy. Statistically significant correlation was shown between total daily dosages of positively charged zinc species and reductions in median (p = 0.005) and mean duration (p < 0.02) of common colds in these trials.
BACKGROUND: The common cold is caused by viruses which cannot be helped by antibiotics. OBJECTIVES: The objective of this review was to assess the effects of antibiotics for the common cold. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, EMBASE, the Family Medicine Database, and reference lists of articles, and we contacted principal investigators. The most recent search was in December 1998. SELECTION CRITERIA: Randomised trials comparing any antibiotic therapy with placebo in acute upper respiratory tract infections. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Main results: Seven trials involving 2056 people aged between six months and 49 years were included. The overall quality of the included trials was variable. People receiving antibiotics did not do better in terms of cure or improvement than those on placebo (odds ratio 0.95, 95% confidence interval 0.70 to 1.28 fixed effects model). One study found a significant benefit for antibiotics compared with placebo for runny nose (clear or purulent). The only other study to evaluate purulent nasal discharge found no significant benefit for antibiotics. Only one study reported work time lost with 22% of those on antibiotic treatment and 25% of those on placebo but this was not significant. Patients treated with antibiotics had a significant increase in side effects (odds ratio 2.72, 95% confidence interval 1.02 to 7.27, random effects model). REVIEWER'S CONCLUSIONS: Reviewers' conclusions: There is not enough evidence of important benefits from the treatment of upper respiratory tract infections with antibiotics and there is a significant increase in adverse effects associated with antibiotic use.
Background : The common cold is one of the most frequent human illnesses and is responsible for substantial morbidity and economic loss. No consistently effective therapy for the common cold has been well documented, but evidence suggests that several possible mechanisms may make zinc an effective treatment. Objective : To test the efficacy of zinc gluconate lozenges in reducing the duration of symptoms caused by the common cold. Design : Randomized, double-blind, placebo-controlled study. Setting : Outpatient department of a large tertiary care center. Patients : 100 employees of the Cleveland Clinic who developed symptoms of the common cold within 24 hours before enrollment. Intervention : Patients in the zinc group (n = 50) received lozenges (one lozenge every 2 hours while awake) containing 13.3 mg of zinc from zinc gluconate as long as they had cold symptoms. Patients in the placebo group (n = 50) received similarly administered lozenges that contained 5% calcium lactate pentahydrate instead of zinc gluconate. Main Outcome Measures : Subjective daily symptom scores for cough, headache, hoarseness, muscle ache, nasal drainage, nasal congestion, scratchy throat, sore throat, sneezing, and fever (assessed by oral temperature). Results : The time to complete resolution of symptoms was significantly shorter in the zinc group than in the placebo group (median, 4.4 days compared with 7.6 days ; P< 0.001). The zinc group had significantly fewer days with coughing (median, 2.0 days compared with 4.5 days ; P= 0.04), headache (2.0 days and 3.0 days ; P = 0.02), hoarseness (2.0 days and 3.0 days ; P = 0.02), nasal congestion (4.0 days and 6.0 days ; P = 0.002), nasal drainage (4.0 days and 7.0 days ; P < 0.001), and sore throat (1.0 day and 3.0 days ; P < 0.001). The groups did not differ significantly in the resolution of fever, muscle ache, scratchy throat, or sneezing. More patients in the zinc group than in the placebo group had side effects (90% compared with 62% ; P < 0.001), nausea (20% compared with 4% ; P = 0.02), and bad-taste reactions (80% compared with 30% ; P < 0.001). Conclusion : Zinc gluconate in the form and dosage studied significantly reduced the duration of symptoms of the common cold. The mechanism of action of this substance in treating the common cold remains unknown. Individual patients must decide whether the possible beneficial effects of zinc gluconate on cold symptoms outweigh the possible adverse effects.
Background: Adults and children in the United States get two to six colds per year. Evidence that zinc is effective therapy for colds is inconsistent. Objective: To test the efficacy of zinc acetate lozenges in reducing the duration of symptoms of the common cold. Design: Randomized, double-blind, placebo-controlled trial. Setting: Detroit Medical Center, Detroit, Michigan. Patients: 50 ambulatory volunteers recruited within 24 hours of developing symptoms of the common cold. Intervention: Participants took one lozenge containing 12.8 mg of zinc acetate or placebo every 2 to 3 hours while awake as long as they had cold symptoms. Measurements: Subjective symptom scores for sore throat, nasal discharge, nasal congestion, sneezing, cough, scratchy throat, hoarseness, muscle ache, fever, and headache were recorded daily for 12 days. Plasma zinc and proinflammatory cytokine levels were measured on day 1 and after participants were well. Results: Forty-eight participants completed the study (25 in the zinc group and 23 in the placebo group). Compared with the placebo group, the zinc group had shorter mean overall duration of cold symptoms (4.5 vs. 8.1 days), cough (3.1 [95% Cl, 2.1 to 4.1] vs. 6.3 [Cl, 4.9 to 7.7] days), and nasal discharge (4.1 [Cl, 3.3 to 4.9] vs. 5.8 [Cl, 4.3 to 7.3] days) and decreased total severity scores for all symptoms (P < 0.002, test for treatment x time interaction). Mean changes in soluble interleukin-1 receptor antagonist level differed nonsignificantly between the zinc group and the placebo group (difference between changes, -89.4 pg/mL [Cl, -243.6 to -64.8 pg/mL]). Conclusion: Administration of zinc lozenges was associated with reduced duration and severity of cold symptoms, especially cough. Improvement in clinical symptoms with zinc treatment may be related to a decrease in proinflammatory cytokine levels; however, in this study, the observed differences between changes in cytokine levels in zinc and placebo recipients were not significant.
W read with interest the recent article by Hasley et al,¹ in which they found that bilateral pleural effusions were independently associated with 30-day mortality, with a relative risk of 2.8. This is a very well done and interesting study. As a clinician seeing patients in various settings, the question that was not directly addressed in the study, but for which the authors clearly have the data, is how much does the presence of bilateral effusion on the chest radiographic examination increase the risk of 30-day mortality compared with other well-known risk factors. For example, in deciding about admitting a patient, clinicians are well aware of the importance of hypoxia, age, comorbid conditions, sepsis, and multiorgan failure as prognostic findings. How did the relative risk of death for the variable "bilateral pleural effusion," in the author's multivariate model, compare with the relative risk of death from other, traditional risk
Background:
In the United States, the common cold has been estimated to cost more than $3.5 billion a year. Despite several randomized clinical trials, the effect of treating colds with zinc salts lozenges remains uncertain because of conflicting results.
Objective:
To conduct a meta-analysis of published randomized clinical trials on the use of zinc salts lozenges in colds using a random effects model.
Results:
Eight clinical trials of treating adults with zinc salts lozenges were identified. After excluding 2 studies that used nasal inoculation of rhinovirus, 6 trials were combined and analyzed. The summary odds ratio for the presence of any cold symptoms at 7 days was 0.50 (95% confidence interval, 0.19-1.29).
Conclusion:
Despite numerous randomized trials, the evidence for effectiveness of zinc salts lozenges in reducing the duration of common colds is still lacking.Arch Intern Med. 1997;157:2373-2376
In a double-blind clinical trial, a total of 463 volunteers were enrolled in a study designed to compare the effects of zinc gluconate lozenges (4.5 mg zinc) and a placebo for common cold. The tablets were to be taken every 1-1 1/2 waking hours at the first symptoms and for the following days until the common cold was over, but for no longer than 10 days. During the winter months of 1987 and 1988, 145 experienced a common cold and 130 completed the study. For final analysis, 61 patients in the zinc lozenge group and 69 patients in the placebo lozenge group were evaluated. Based on the patients' records the duration and severity of the common cold were compared. No statistically significant differences were found between the patient groups. Two recent studies using a five-time higher zinc dose per lozenge for common cold showed a significant, positive effect, but associated with frequent side-effects, first of all taste distortion. In the present study there was a weak tendency (not statistically significant, p = 0.12) towards more patients in the zinc lozenge group than in the placebo lozenge group reporting side-effects.
Zinc is a trace metal with in vitro activity against rhinovirus, the major etiologic agent in acute upper respiratory tract
infections (URIs). A previous trial of zinc gluconate supported its efficacy in treating URIs, but the effectiveness of blinding
was uncertain. We conducted a prospective randomized trial of zinc gluconate versus a taste-matched placebo of sucrose octaacetate.
Lozenges containing either 23 mg of elemental zinc or placebo were taken every 2 h. Eleven URI symptoms were rated daily on
a scale of 0 (not present) to 3 (severe). Duration of illness, reflected in the proportion of subjects remaining symptomatic
on each day, was not significantly reduced (maximum difference of 12.6% on day 7, P = 0.09; 95% confidence interval, -6 to
31%) by either treatment. Severity of illness, assessed by using a summed severity score, was reduced incrementally by 7 to
8% on days 5 to 7 (P = 0.02) in subjects taking zinc. Adverse effects, mostly nausea and altered taste, were reported by 50%
of subjects taking zinc. We conclude that while zinc gluconate may produce a small reduction in overall severity of symptoms,
this is not clinically significant. Given the additional high incidence of adverse effects, zinc gluconate cannot be recommended
for use in the treatment of acute URIs.
Following a tolerance study, double-blind placebo controlled trials were conducted to determine the prophylactic effect of zinc gluconate lozenges on rhinovirus challenge and, in a third study, their therapeutic efficacy when given at the start of colds caused by virus inoculation was tested.
In the prophylaxis study a total of 57 volunteers received lozenges of either zinc gluconate (23 mg) (29 volunteers) or matched placebo (28 volunteers) every 2 h while awake during a period of four and a half days. They were challenged with 10² tissue culture infecting dose (TCID50) of human rhinovirus 2 (HRV-2) on the second day of medication, and were monitored daily for symptoms and signs of colds and laboratory evidence of infection. Zinc reduced the total mean clinical score from 8.2 in the placebo group to 5.7 and the reduction of the mean clinical score was statistically significant on the second day after virus challenge.
In the therapeutic study 69 volunteers were inoculated with 10² TCID50 of HRV-2 and those who developed cold symptoms were randomly allocated to receive either zinc gluconate lozenges (six volunteers) or matched placebo lozenges (six volunteers) every two hours they were awake for six days. Treatment of colds with zinc reduced the mean daily clinical score and this was statistically significant on the fourth and fifth day of medication. Similarly, medication also reduced the mean daily nasal secretion weight and total tissue count and these reductions were statistically significant on days two and six for nasal secretion weights and days four to six of medication for tissue counts when compared with placebo. There were also statistically significant reductions in the mean total nasal secretion weights and total tissue counts. Zinc, however, had no significant effect on the rate or amount of virus excreted by volunteers.
We conclude that zinc gluconate lozenges are reasonably well tolerated and that they have a significant effect on the signs and symptoms of colds caused by rhinoviruses, although the mechanism of action remains obscure.
The common cold is one of the most frequent human illnesses and is responsible for substantial morbidity and economic loss. No consistently effective therapy for the common cold has been well documented, but evidence suggests that several possible mechanisms may make zinc an effective treatment.
To test the efficacy of zinc gluconate lozenges in reducing the duration of symptoms caused by the common cold.
Randomized, double-blind, placebo-controlled study.
Outpatient department of a large tertiary care center.
100 employees of the Cleveland Clinic who developed symptoms of the common cold within 24 hours before enrollment.
Patients in the zinc group (n = 50) received lozenges (one lozenge every 2 hours while awake) containing 13.3 mg of zinc from zinc gluconate as long as they had cold symptoms. Patients in the placebo group (n = 50) received similarly administered lozenges that contained 5% calcium lactate pentahydrate instead of zinc gluconate.
Subjective daily symptom scores for cough, headache, hoarseness, muscle ache, nasal drainage, nasal congestion, scratchy throat, sore throat, sneezing, and fever (assessed by oral temperature).
The time to complete resolution of symptoms was significantly shorter in the zinc group than in the placebo group (median, 4.4 days compared with 7.6 days; P < 0.001). The zinc group had significantly fewer days with coughing (median, 2.0 days compared with 4.5 days; P = 0.04), headache (2.0 days and 3.0 days; P = 0.02), hoarseness (2.0 days and 3.0 days; P = 0.02), nasal congestion (4.0 days and 6.0 days; P = 0.002), nasal drainage (4.0 days and 7.0 days; P < 0.001), and sore throat (1.0 day and 3.0 days; P < 0.001). The groups did not differ significantly in the resolution of fever, muscle ache, scratchy throat, or sneezing. More patients in the zinc group than in the placebo group had side effects (90% compared with 62%; P < 0.001), nausea (20% compared with 4%; P = 0.02), and bad-taste reactions (80% compared with 30%; P < 0.001),
Zinc gluconate in the form and dosage studied significantly reduced the duration of symptoms of the common cold. The mechanism of action of this substance in treating the common cold remains unknown. Individual patients must decide whether the possible beneficial effects of zinc gluconate on cold symptoms outweigh the possible adverse effects.
To examine the evidence of seven randomized controlled trials (RCT) on the therapeutic effectiveness of zinc gluconate lozenges for treating the common cold.
Using the MeSH headings common cold and zinc gluconate, MEDLINE was searched from 1966 on for all published RCTs evaluating use of zinc gluconate for treating the common cold.
For this study, only double-blind RCTs were included.
Fair evidence suggests that zinc gluconate lozenges have a therapeutic effect in treating the common cold. Starting therapy with zinc gluconate lozenges within 24 to 48 hours of onset of cold symptoms reduces the duration and severity of the cold. Patients must suck lozenges every 2 hours while awake during the cold. Minimum effective dose appears to be 13.3 mg of elemental zinc per lozenge. Evidence suggests that compounds such as citric acid, sorbitol, and mannitol bind the free zinc ion in the mouth, and this could account for variations in therapeutic benefit. Bad taste and nausea are important side effects of zinc lozenges.
Evidence supports use of zinc gluconate lozenges for reducing the symptoms and duration of the common cold, but the side effects, bad taste, and therapeutic protocol might limit patient compliance.
The common cold is one of the most frequently occurring illnesses and is responsible for substantial morbidity and economic loss. Biochemical evidence suggests that zinc may be an effective treatment, and zinc gluconate glycine (ZGG) lozenges have been shown to reduce the duration of cold symptoms in adults.
To determine the efficacy of ZGG treatment of colds in children and adolescents.
A randomized, double-masked, placebo-controlled study.
Two suburban school districts in Cleveland, Ohio.
A total of 249 students in grades 1 through 12 were enrolled within the first 24 hours of experiencing at least 2 of 9 symptoms of the common cold.
Zinc lozenges, 10 mg, orally dissolved, 5 times a day (in grades 1-6) or 6 times a day (in grades 7-12).
Time to resolution of cold symptoms based on subjective daily symptom scores for cough, headache, hoarseness, muscle ache, nasal congestion, nasal drainage, scratchy throat, sore throat, and sneezing.
Time to resolution of all cold symptoms did not differ significantly between students receiving zinc (n = 124) and those receiving placebo (n = 125) (median, 9 days; 95% confidence interval [CI], 8-9 days; median, 9 days, 95% CI, 7-10 days, respectively; P=.71). There were no significant differences in the time to resolution of any of the 9 symptoms studied. Compared with controls, more students in the zinc group reported adverse effects (88.6% vs 79.8%; P=.06); bad taste (60.2% vs 37.9%; P=.001); nausea (29.3% vs 16.1%; P=.01); mouth, tongue, or throat discomfort (36.6% vs 24.2%; P=.03); and diarrhea (10.6% vs 4.0%; P=.05).
In this community-based, randomized controlled trial, ZGG lozenges were not effective in treating cold symptoms in children and adolescents. Further studies with virologic testing are needed to clarify what role, if any, zinc may play in treating cold symptoms.
Extracts of the plant Echinacea (family Compositae) are widely used in some European countries and the USA for upper respiratory tract infections.
The objective of this review was to assess the effects of preparations containing extracts of Echinacea in the prevention and treatment of the common cold.
We searched the Cochrane Acute Respiratory Infections Group and Complementary Medicine Field's trials registers, MEDLINE, EMBASE, Phytodok and reference lists of articles. We also contacted researchers and manufacturers. Date of last search: Spring 1998.
Randomised and quasi-randomised trials comparing preparations containing an extract of Echinacea compared with a placebo, no treatment, or another treatment for common colds.
At least two independent reviewers assessed trial quality and extracted data.
Sixteen trials (eight prevention trials, and eight trials on treatment of upper respiratory tract infections) with a total of 3396 participants were included. Variation in preparations investigated and methodological quality of trials precluded quantitative meta-analysis. Overall, the results suggested that some Echinacea preparations may be better than placebo.
The majority of the available studies report positive results. However there is not enough evidence to recommend a specific Echinacea product, or Echinacea preparations for the treatment or prevention of common colds.
Adults and children in the United States get two to six colds per year. Evidence that zinc is effective therapy for colds is inconsistent.
To test the efficacy of zinc acetate lozenges in reducing the duration of symptoms of the common cold.
Randomized, double-blind, placebo-controlled trial.
Detroit Medical Center, Detroit, Michigan.
50 ambulatory volunteers recruited within 24 hours of developing symptoms of the common cold.
Participants took one lozenge containing 12.8 mg of zinc acetate or placebo every 2 to 3 hours while awake as long as they had cold symptoms.
Subjective symptom scores for sore throat, nasal discharge, nasal congestion, sneezing, cough, scratchy throat, hoarseness, muscle ache, fever, and headache were recorded daily for 12 days. Plasma zinc and proinflammatory cytokine levels were measured on day 1 and after participants were well.
Forty-eight participants completed the study (25 in the zinc group and 23 in the placebo group). Compared with the placebo group, the zinc group had shorter mean overall duration of cold symptoms (4.5 vs. 8.1 days), cough (3.1 [95% CI, 2.1 to 4.1] vs. 6.3 [CI, 4.9 to 7.7] days), and nasal discharge (4.1 [CI, 3.3 to 4.9] vs. 5.8 [CI, 4.3 to 7.3] days) and decreased total severity scores for all symptoms (P < 0.002, test for treatment x time interaction). Mean changes in soluble interleukin-1 receptor antagonist level differed nonsignificantly between the zinc group and the placebo group (difference between changes, -89.4 pg/mL [CI, -243.6 to -64.8 pg/mL]).
Administration of zinc lozenges was associated with reduced duration and severity of cold symptoms, especially cough. Improvement in clinical symptoms with zinc treatment may be related to a decrease in proinflammatory cytokine levels; however, in this study, the observed differences between changes in cytokine levels in zinc and placebo recipients were not significant.
We performed a randomized, double-blind, placebo-controlled trial to evaluate the efficacy of 0.12% zinc sulfate nasal spray for reducing the duration and severity of acute upper respiratory infections.
Patients with acute onset of upper respiratory illness of less than 24 hours' duration were eligible for the study. A nasopharyngeal swab was obtained at the time of enrollment for viral culture. Participants were randomly assigned to receive either 0.12% zinc sulfate or isotonic placebo spray. The medication was administered as two inhalations in each nostril four times a day. Each patient completed a diary card twice a day to record oral temperature, symptoms, and adverse effects. Symptoms were scored as absent (0), mild (1), moderate (2), or severe (3).
One hundred eighty-five subjects volunteered to participate, and 160 met the criteria for enrollment. The median duration of all symptoms was 7 days in both groups (P = 0.45), and the median duration of nasal symptoms was 6 days in both groups (P= 0.12). After adjustment for baseline differences in severity, patients receiving zinc had a significant reduction in the total symptom score (P= 0.02) and the nasal symptom score (P= 0.02) on day 1, but not on any of the other days. Adverse effects were mild and had no significant association with the use of zinc. A respiratory virus was identified in 9 of the 160 participants; 6 of these were rhinovirus.
A low concentration of zinc sulfate nasal spray had no effect on the duration of the common cold.
Antivirals may provide limited help for the common cold but they are not a cure and none are licensed The common cold is a short, usually mild illness with chest and nasal symptoms, such as a runny nose. Other diseases are allied to colds and they are very common, especially in young children. Numerous antiviral drugs are available but the review of trials found there are no licensed effective antivirals for the common cold. The review also found that while intranasal interferons (IFNs) appear to have good antiviral properties, they also cause adverse effects such as blood-tinged nose discharge that make them unacceptable in everyday use. Other drugs, such as Pleconaril and Impulsin need more research.
Zinc has generally been administered by the oral route in studies of prevention or treatment of the common cold. The purpose
of these studies was to evaluate the effectiveness of intranasal zinc gluconate for prevention of experimental rhinovirus
infection and illness. Ninety-one volunteers, 41 treated with active medication and 50 treated with placebo, received study
medication for 3 days, were inoculated with rhinovirus, and then were treated with study medication for an additional 6 days.
Rhinovirus infection was documented in 37 (74%) of the 50 placebo-treated volunteers and in 32 (78%) of the 41 volunteers
treated with active medication. Zinc treatment had no effect on total symptom score, rhinorrhea, nasal obstruction, or the
proportion of infected volunteers who developed clinical colds. These data do not support a role for intranasal zinc gluconate
for prevention or treatment of the common cold.
To examine whether intake of vitamin C and zinc is associated with a decrease in the risk of a common cold, we analyzed data from a cohort study carried out in a population of 4,272 faculty and staff from five Spanish universities. Participants were 21-65 years of age, were full-time workers at those universities, and did not have antecedents of asthma or chronic obstructive pulmonary disease. Daily intake of vitamin C and zinc was assessed at baseline by means of a food frequency questionnaire of which the validity and reproducibility were determined in a sample of the population. Subjects were traced for 1 year to detect episodes of common cold, the diagnosis of which was based on symptoms and was validated by additional clinical signs. We detected 1,667 cases of common cold in 79,240 person-weeks of follow-up. Intake of vitamin C and zinc was not related to the occurrence of common cold. Compared with the first quartile of intake, women in the fourth quartile of vitamin C intake showed an adjusted incidence rate ratio of 1.0 (95% CI = 0.7-1.3), and for zinc intake this figure was 1.1 (95% CI = 0.8-1.5). The incidence rate ratios for men in the fourth quartile were 1.1 (95% CI = 0.8-1.4) for vitamin C and 1.3 (95% CI = 0.9-1.8) for zinc.
Previous studies suggest that zinc salts may be effective in treating the common cold. Since rhinovirus infections occur primarily in the nasal cavity, an attempt to arrest the infection at the portal of entry seems logical.
To assess the ability of zinc nasal gel to shorten the duration and reduce the severity of the common cold in healthy adults.
Randomized, double blind, placebo-controlled study.
Of 1087 patients screened by telephone, 80 patients were enrolled, all presenting within 24-48 h of the onset of illness. They received one dose per nostril of a nasal gel spray containing either 33 mmol/l zincum gluconicum, or an identical placebo four times daily until their symptoms resolved, for a maximum of 10 days.
Median duration of cold symptoms in the zinc group was significantly shorter than in the placebo group (median [IQR] 4.3 days [2.5-5.5] vs. 6 days [5-8.5], p=0.002). Nasal drainage, nasal congestion, hoarseness, and sore throat were the symptoms most affected. Significant reduction of total symptom scores started from the second day of the study. Adverse effects (mainly nasal stinging) were similar in both groups.
Zincum gluconicum nasal gel shortens duration and reduces symptom severity of the common cold in healthy adults, when started within 24-48 h of the onset of illness.
Each year, more than 62 million cases of the common cold in the United States require medical attention and more than 80% affect school-aged children. The objective of this prospective, intent-to-treat, phase IV study was to determine the therapeutic and prophylactic effectiveness of zinc gluconate glycine lozenges (Cold-Eeze) for the common cold. Zinc lozenges were administered once daily during the cold season for prophylaxis. For therapeutic purposes, lozenges were given 4 times per day. The primary objective of the study was the treatment effect on cold duration, and the secondary objective was the effect on the number of common colds. A putative control from our previous study was used for comparison. A total of 178 children, ages 12 to 18 years, was enrolled, of which 134 met criteria for efficacy analysis. The average cold duration with therapeutic lozenge use was 6.9 +/- 3.1 days, significantly shorter than the 9.0 +/- 3.5 days found in the control group (P < 0.001). The mean number of colds was 1.28 +/- 1.03 with zinc lozenge prophylaxis versus 1.7 +/- 1.91 without prophylaxis (P < 0.05), a 25% reduction. With prophylaxis, 25% of the subjects did not experience a cold and two-thirds never had a cold or only had 1 cold. There was no antibiotic use for any cold, and there were no adverse events reported. Results of this study are consistent with those from our previous retrospective study showing significantly shorter cold duration and fewer colds with the use of zinc gluconate glycine lozenges. The zinc gluconate glycine lozenges are well tolerated and are an easy-to-administer therapy that has the potential to substantially reduce cold-related school absences and antibiotic use and misuse as well as to provide a cost saving.
To review the laboratory and clinical evidence of the medicinal value of zinc for the treatment of the common cold.
Published articles identified through Medline (1980-2003) using the search terms zinc, rhinovirus, and other pertinent subject headings. Additional sources were identified from the bibliographies of the retrieved articles.
By the author.
By the author.
Human rhinoviruses, by attaching to the nasal epithelium via the intracellular adhesion molecule-1 (ICAM-1) receptor, cause most colds. Ionic zinc, based on its electrical charge, also has an affinity for ICAM-1 receptor sites and may exert an antiviral effect by attaching to the ICAM-1 receptors in the rhinovirus structure and nasal epithelial cells. Clinical tests of zinc for treatment of common colds have been inconsistent, primarily because of study design, blinding, and lozenge contents. Early formulations of lozenges also were unpalatable. In three trials with similar study designs, methodologies, and efficacy assessments, zinc effectively and significantly shortened the duration of the common cold when it was administered within 24 hours of the onset of symptoms. Recent reports of trials with zinc gluconate administered as a nasal gel have supported these findings; in addition, they have shown that treatment with zinc nasal gel is effective in reducing the duration and severity of common cold symptoms in patients with established illness.
Clinical trial data support the value of zinc in reducing the duration and severity of symptoms of the common cold when administered within 24 hours of the onset of common cold symptoms. Additional clinical and laboratory evaluations are warranted to further define the role of ionic zinc for the prevention and treatment of the common cold and to elucidate the biochemical mechanisms through which zinc exerts its symptom-relieving effects.
Preparations of the plant Echinacea (family Compositae) are widely used in some European countries and in North America for common colds. Most consumers and physicians are not aware that products available under the term Echinacea differ appreciably in their composition, mainly due to the use of variable plant material, extraction methods and addition of other components.
The objective of this review was to assess whether there is evidence that Echinacea preparations are 1) more effective than no treatment; 2) more effective than placebo; 3) similarly effective to other treatments in A) the prevention and B) the treatment of the common cold.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2005); PubMed (1997 to April 2005), EMBASE (1998 to June 2005), AMED (to August 2005), Centre for Complementary Medicine Research (in Munich) (1988 to May 2005), contacted experts, and screened references of reviews.
We included randomized controlled trials that compared mono-preparations of Echinacea with a placebo, no treatment, or another treatment for the prevention or treatment of common colds. Trials on combinations of Echinacea and other herbs were excluded.
For all studies, at least two authors independently assessed eligibility and trial quality, and extracted data. Outcomes of interest in prevention trials were: numbers of individuals with one or more colds, and severity and duration of colds; and in treatment trials: total symptom scores, nasal symptoms, and duration of colds.
Sixteen trials including a total of 22 comparisons of an Echinacea preparation and a control group (19 with placebo, 2 with no treatment, 1 with another herbal preparation) met the inclusion criteria. All trials except one were described as double-blind. The majority had reasonable to good methodological quality. Three comparisons investigated prevention of colds and 19 comparisons tested treatment of colds. A variety of different Echinacea preparations were used. None of the three comparisons in the prevention trials showed an effect over placebo. Comparing an Echinacea preparation with placebo as treatment, a significant effect was reported in nine comparisons, a trend in one, and no difference in six. More than one trial was available only for preparations based on the aerial parts from Echinacea purpurea (E. purpurea).
Echinacea preparations tested in clinical trials differ greatly. There is some evidence that preparations based on the aerial parts of Echinacea purpurea might be effective for the early treatment of colds in adults but results are not fully consistent. Beneficial effects of other Echinacea preparations, and for preventative purposes might exist but have not been shown in independently replicated, rigorous randomized trials.
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