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Zinc for the prevention or treatment of acute viral respiratory tract infections in adults: a rapid systematic review and meta-analysis of randomised controlled trials.
Hunter, Jennifer; Arentz, Susan; Goldenberg, Joshua; Yang, Guoyan; Beardsley, Jennifer; Myers, Stephen P; Mertz, Dominik; Leeder, Stephen.
  • Hunter J; NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia Jennifer.Hunter@westernsydney.edu.au.
  • Arentz S; NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.
  • Goldenberg J; Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon, USA.
  • Yang G; NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.
  • Beardsley J; Seattle, Washington, USA.
  • Myers SP; NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia.
  • Mertz D; National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia.
  • Leeder S; Division of Infectious Diseases, Department of Medicine, Health Sciences, McMaster University, Hamilton, Ontario, Canada.
BMJ Open ; 11(11): e047474, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1501711
ABSTRACT

OBJECTIVE:

To evaluate the benefits and risks of zinc formulations compared with controls for prevention or treatment of acute viral respiratory tract infections (RTIs) in adults.

METHOD:

Seventeen English and Chinese databases were searched in April/May 2020 for randomised controlled trials (RCTs), and from April/May 2020 to August 2020 for SARS-CoV-2 RCTs. Cochrane rapid review methods were applied. Quality appraisals used the Risk of Bias 2.0 and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS:

Twenty-eight RCTs with 5446 participants were identified. None were specific to SARS-CoV-2. Compared with placebo, oral or intranasal zinc prevented 5 RTIs per 100 person-months (95% CI 1 to 8, numbers needed to treat (NNT)=20, moderate-certainty/quality). Sublingual zinc did not prevent clinical colds following human rhinovirus inoculations (relative risk, RR 0.96, 95% CI 0.77 to 1.21, moderate-certainty/quality). On average, symptoms resolved 2 days earlier with sublingual or intranasal zinc compared with placebo (95% CI 0.61 to 3.50, very low-certainty/quality) and 19 more adults per 100 were likely to remain symptomatic on day 7 without zinc (95% CI 2 to 38, NNT=5, low-certainty/quality). There were clinically significant reductions in day 3 symptom severity scores (mean difference, MD -1.20 points, 95% CI -0.66 to -1.74, low-certainty/quality), but not average daily symptom severity scores (standardised MD -0.15, 95% CI -0.43 to 0.13, low-certainty/quality). Non-serious adverse events (AEs) (eg, nausea, mouth/nasal irritation) were higher (RR 1.41, 95% CI 1.17 to 1.69, NNHarm=7, moderate-certainty/quality). Compared with active controls, there were no differences in illness duration or AEs (low-certainty/quality). No serious AEs were reported in the 25 RCTs that monitored them (low-certainty/quality).

CONCLUSIONS:

In adult populations unlikely to be zinc deficient, there was some evidence suggesting zinc might prevent RTIs symptoms and shorten duration. Non-serious AEs may limit tolerability for some. The comparative efficacy/effectiveness of different zinc formulations and doses were unclear. The GRADE-certainty/quality of the evidence was limited by a high risk of bias, small sample sizes and/or heterogeneity. Further research, including SARS-CoV-2 clinical trials is warranted. PROSPERO REGISTRATION NUMBER CRD42020182044.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Tract Infections / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Humans Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-047474

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Tract Infections / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Adult / Humans Language: English Journal: BMJ Open Year: 2021 Document Type: Article Affiliation country: Bmjopen-2020-047474