Background Pneumonia is a leading cause of morbidity and mortality in young children. Early reversal of severity signs - chest indrawing, hypoxia, and tachypnoea - improves outcome. We postulated that zinc, an acute phase reactant, would shorten duration of severe pneumonia and time in hospital. Methods In a double-blind placebo-controlled clinical trial in Matlab Hospital, Bangladesh, 270 children aged 2-23 months were randomised to receive elemental zinc (20 mg per day) or placebo, plus the hospital's standard antimicrobial management, until discharge. The outcomes were time to cessation of severe pneumonia (no chest indrawing, respiratory rate 50 per min or less, oxygen saturation at least 95% on room air) and discharge from hospital. Discharge was allowed when respiratory rate was 40 per minute or less for 24 consecutive hours while patients were maintained only on oral antibiotics. Findings The group receiving zinc had reduced duration of severe pneumonia (relative hazard [RH]=0·70, 95% CI 0·51-0·98), including duration of chest indrawing (0·80, 0·61-1·05), respiratory rate more than 50 per min (0·74, 0·57-0·98), and hypoxia (0·79, 0·61-1·04), and overall hospital duration (0·75, 0·57-0·99). The mean reduction is equivalent to 1 hospital day for both severe pneumonia and time in hospital. All effects were greater when children with wheezing were omitted from the analysis. Interpretation Adjuvant treatment with 20 mg zinc per day accelerates recovery from severe pneumonia in children, and could help reduce antimicrobial resistance by decreasing multiple antibiotic exposures, and lessen complications and deaths where second line drugs are unavailable.
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