What is the role of zinc in managing Acute Gastroenteritis (AGE) in children?

Role of Zinc in Acute Gastroenteritis in Children

Oral zinc supplementation is strongly recommended for children aged 6 months to 5 years with acute gastroenteritis, particularly in those with malnutrition or living in areas with high zinc deficiency prevalence. 1

Efficacy of Zinc in AGE

Zinc supplementation has demonstrated significant benefits in the management of acute gastroenteritis in children:

• Reduces diarrhea duration by approximately 10 hours in children 6 months to 5 years of age, with a greater reduction (27 hours) in children with signs of malnutrition 2, 1
• Decreases diarrhea persistence - fewer children still have diarrhea after 7 days of treatment (moderate certainty evidence) 3
• More effective in specific populations:
  • Children older than 6 months of age (low to moderate certainty evidence) 3
  • Children with signs of malnutrition (high certainty evidence) 3
  • Children in areas with high zinc deficiency prevalence 1, 3

Dosage Recommendations

• Children 6 months to 5 years: 20 mg of elemental zinc daily for 10-14 days 1
• Infants under 6 months: 10 mg of elemental zinc daily for 10-14 days 1
• Zinc should be administered along with oral rehydration solution (ORS) for maximum benefit 1

Important Considerations

Population-Specific Effects

• Zinc supplementation may not be beneficial in all populations:
  • Limited efficacy in well-nourished children and those living in areas with low zinc deficiency prevalence 3, 4
  • May not be effective in infants younger than 6 months - evidence suggests no significant effect on diarrhea duration or persistence in this age group 3

Administration Guidelines

• Zinc should be given between meals to maximize absorption 1
• Should be administered alongside standard oral rehydration therapy, not as a replacement 1
• Continue normal feeding and breastfeeding throughout the diarrheal episode 1

Safety Profile

• Zinc supplementation may increase the risk of vomiting (moderate certainty evidence) 3
• No serious adverse events have been reported in clinical trials 3

Comprehensive Management Approach

Zinc supplementation should be part of a comprehensive approach to managing AGE in children:

1. Oral rehydration therapy remains the cornerstone of treatment 1
2. Continue breastfeeding throughout the diarrheal episode 1
3. Resume age-appropriate diet during or immediately after rehydration 1
4. Avoid antimotility drugs (e.g., loperamide) in children under 18 years with acute diarrhea 1
5. Add zinc supplementation as an adjunctive therapy in appropriate populations 2, 1

Regional Considerations

The effectiveness of zinc supplementation varies by geographic region and nutritional status:

• Highly effective: In developing countries or regions with high zinc deficiency prevalence 3
• Limited evidence of benefit: In developed countries where zinc deficiency is rare 4

A randomized controlled trial in Polish children showed no significant difference in diarrhea duration between zinc and placebo groups, suggesting limited benefit in populations where zinc deficiency is uncommon 4.