Abstract: Clinical Infectious Diseases
RESEARCH ARTICLE
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Twice daily oral zinc in the treatment of patients with
Coronavirus Disease-19
A randomized double-blind controlled trial
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Saoussen Ben Abdallah1, MD Yosra Mhalla13, MD Imen Trabelsi3, PhD Adel Sekma2,3, MD
Rim Youssef3,4, MD Khaoula Bel Haj Ali2,3, MD Houda Ben Soltane3,5, MD HajerYacoubi3,4,
MD Mohamed Amine Msolli2,3, MD Nejla Stambouli6, PhD Kaouthar Beltaief2,3, MD
Mohamed Habib Grissa2,3, MD Meriem Khrouf3,5, MD Zied Mezgar3,5, MD Chawki
Loussaief7, MD Wahid Bouida2,3, MD Rabie Razgallah8, MD Karima Hezbri9, PhD Asma
Belguith10, MD Naouel Belkacem11, MD Zohra Dridi12, MD Hamdi Boubaker2,3, MD Riadh
Boukef3,4, MD Semir Nouira2,3, MD
1
Medical intensive care unit, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia;
Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia;
3
Research Laboratory LR12SP18 University of Monastir, 5019 Tunisia; 4Emergency Department,
Sahloul University Hospital, 4011 Sousse, Tunisia; 5Emergency Department, Farhat Hached
University Hospital, 4011 Sousse, Tunisia; 6UR17DN03 - Research Unit, Military Defense,
Military Hospital of Tunis, Tunisia; 7Department of Infectious Disease Fattouma Bourguiba
University Hospital, 5000 Monastir, Tunisia; 8DACIMA Consulting 1053 Tunis, Tunisia;
9
Medical affairs manager, Opalia Recordati, Tunis, Tunisia; 10Department of Preventive Medicine,
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Corresponding author: Pr. Semir Nouira, Emergency Department and Laboratory Research (LR12SP18),
Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia; +216 73 106 046. E-mail :
semir.nouira@rns.tn.
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Alternate corresponding author: Dr. Khaoula Bel Haj Ali, Emergency Department and Laboratory
Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia. +216 29777277.
E-mail : belhajalikhaoula@yahoo.fr.
© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of
America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article
is published and distributed under the terms of the Oxford University Press, Standard Journals Publication
Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_
publication_model)
DOI: 10.1093/cid/ciac807
1
Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; 11District hospital Teboulba,
Tunisia; 12Department of cardiology, Fattouma Bourguiba University Hospital, 5000 Monastir,
Tunisia; 13Laboratory of microbiology, Fattouma Bourguiba University Hospital, 5000 Monastir,
Tunisia;
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Background: Zinc supplementation has been considered one of the potential therapies for
coronavirus disease-19 (COVID-19). We aimed to examine zinc efficacy in adult patients with
COVID-19 infection.
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Methods: We conducted a prospective, randomized, double-blind, placebo-controlled, multicenter
trial. Patients tested positive for COVID-19 without end organ failure were randomized to oral
zinc (n=231) or matching placebo (n=239) for 15 days. The primary combined outcome was death
due to COVID-19 or ICU admission within 30 days after randomization. Secondary outcomes
included length of hospital stay for inpatients and duration of COVID-19 symptoms with COVID19 related hospitalization for outpatients.
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Findings: One hundred ninety patients (40.4%) were ambulatory and 280..
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec>\n'
' <jats:title>BACKGROUND</jats:title>\n'
' <jats:p>Zinc supplementation has been considered one of the potential '
'therapies for coronavirus disease-19 (COVID-19). We aimed to examine zinc efficacy in adult '
'patients with COVID-19 infection.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>METHODS</jats:title>\n'
' <jats:p>We conducted a prospective, randomized, double-blind, '
'placebo-controlled, multicenter trial. Patients tested positive for COVID-19 without end '
'organ failure were randomized to oral zinc (n\u2009=\u2009231) or matching placebo (n\u2009'
'=\u2009239) for 15 days. The primary combined outcome was death due to COVID-19 or ICU '
'admission within 30 days after randomization. Secondary outcomes included length of hospital '
'stay for inpatients and duration of COVID-19 symptoms with COVID-19 related hospitalization '
'for outpatients.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>FINDINGS</jats:title>\n'
' <jats:p>One hundred ninety patients (40.4%) were ambulatory and 280 '
'patients (59.6%) were hospitalized. Mortality at 30-day was 6.5% in Zinc group and 9.2% in '
'Placebo group [odds ratio (OR) 0.70 (0.37-1.32)]; ICU admission rate was respectively 5.2% '
'and 11.3% [OR 0.46 (0.23-0.88)]. Combined outcome was lower in zinc group compared to placebo '
'group [OR 0.62 (0.38-0.99)]. Consistent results were observed in prespecified subgroups of '
'patients with age\u2009&lt;\u200965 years, those with comorbidity, and those who needed '
'oxygen therapy at baseline. Length of hospital stay was shorter in zinc group compared to '
'placebo group [difference 3.5 days, 95% CI (2.76-4.23)] in inpatients group; duration of '
'COVID-19 symptoms decreased with zinc treatment compared to placebo in outpatients '
'[difference 1.9 days, 95% CI (0.62-2.6)]. No severe adverse events were observed during the '
'study.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec>\n'
' <jats:title>INTERPRETATION</jats:title>\n'
' <jats:p>Our results showed that in COVID-19 patients, oral zinc can '
'decrease 30-day death and ICU admission rate and can shorten symptoms duration.</jats:p>\n'
' </jats:sec>',
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'title': 'Twice daily oral zinc in the treatment of patients with Coronavirus Disease-19 <i>A randomized '
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{ 'given': 'Zied',
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