selain menggunakan larutan elektrolit untuk membantu mengatasi diare pada anak, WHO sudah lama menerapkan panduan penggunaan zinc, yang selain membantu kesembuhan dari diare juga mencegah keterulangan diare pada beberapa bulan ke depannya.

Zinc Alone Good Enough in Children With Acute Diarrhea

NEW YORK (Reuters Health) May 27, 2011 — Results of a randomized controlled trial confirm the benefit of zinc in children with acute dehydrating diarrhea and suggest no real benefit of additional supplementation with vitamin A and a combination of micronutrients.

"We expected to find a better therapeutic effect with combined therapy," said Dr. Phalguni Dutta and colleagues from the National Institute of Cholera and Enteric Diseases in Kolkata, India.

But combined therapy did not have any added advantage over zinc alone, reported online May 18 in the Journal of Pediatrics.

The World Health Organization and United Nations Children's Fund both recommend zinc supplementation for children with diarrhea. "Despite strong supportive evidence, it has not yet been globally accepted as a therapeutic agent," the investigators note.

They also note that vitamin A deficiency is a major problem in developing countries, and trials of vitamin A supplementation have shown it can reduce the severity and duration of diarrhea, and even related mortality. Deficiencies in copper, iron, folate, vitamin B12 and selenium are also common in children from developing countries.

Dr. Dutta and colleagues compared the efficacy of zinc, vitamin A and micronutrient supplementation in 167 children, aged 6 to 24 months, who were hospitalized at the Dr. B. C. Roy Memorial Hospital for Children in Kolkata, with acute watery diarrhea and moderate dehydration during March 1999 and May 2001.

Subjects were randomly assigned to zinc plus placebo (group 1; n = 41), zinc plus other micronutrients plus vitamin A (group 2; n = 39), zinc plus vitamin A (group 3; n = 44), or placebo (group 4; n = 43) as an adjunct to oral rehydration solution.

The daily dose of zinc was 20 mg, twice the Recommended Daily Allowance. The daily micronutrient combination consisted of zinc (20 mg), iron (10 mg), copper (2 mg), selenium (40 mg), vitamin B12 (1.4 mg), and folate (100 mg). Vitamin A was given on admission following national guidelines (age < 1 year, 100,000 IU; age > 1 year, 200,000 IU).

The investigators report that all of the children were successfully managed with oral rehydration solution; none required intravenous fluid or developed any complications during the study.

Compared with placebo, children in the three supplemented groups had significant (P < 0.0001) reductions in the major outcome variables: duration and volume of diarrhea, and intake of oral rehydration solution.

The percentage of children who recovered within 5 days was 93%, 100%, and 98% for groups 1, 2, and 3, compared with 68% for group 4 (placebo). The duration of diarrhea after the start of therapy was 64 hours in groups 1 and 2, 59 hours in group 3, and 88 hours in group 4.

The greatest reduction in outcome variables and most rapid recovery were seen in group 2 (zinc plus micronutrients/vitamin A) and group 3 (zinc plus vitamin A), respectively, the investigators note, but the differences among the supplemented groups were not statistically significant.

The difference in cure rate was statistically significant between the supplemented groups and the placebo group but not among the supplemented groups.

Limitations of the study include a small sample size, which might have failed to detect a favorable impact of combined therapy. The failure to measure zinc levels in the children is another limitation.

Summing up, they say their study supports the use of zinc supplements as add-on therapy in children with acute diarrhea. They say a well-designed clinical trial with larger sample sizes is needed to better understand the beneficial effects of combined therapy with micronutrients and vitamins in children with diarrhea.

J Pediatr. Published online May 18, 2011.