Zinc for the common cold

The common cold is often caused by the rhinovirus. It is one of the most widespread illnesses and is a leading cause of visits to the doctor and absence from school and work. Complications of the common cold include ear infection, sinusitis and exacerbations of reactive airway diseases. There is no proven treatment for the common cold. However, an even partially effective treatment for treating and preventing the common cold could markedly reduce the health problems and economic losses associated with it.

Zinc inhibits replication of the virus and has been tested in trials for treatment of the common cold. This review identified 18 randomised controlled trials, enrolling 1781 participants of all age groups, comparing zinc with placebo (no zinc). We found that zinc (lozenges or syrup) reduces the average duration of the common cold in healthy people, when taken within 24 hours of onset of symptoms. In people taking zinc their cold symptoms are also less likely to persist beyond seven days of treatment. Prophylactic zinc supplementation for at least five months reduces incidence, school absences and prescription of antibiotics for children with the common cold, although antibiotics are not required for the common cold. People in whom common cold symptoms might be troublesome (for example, those with underlying chronic illness, immunodeficiency, asthma, etc.) have not been studied, so the use of zinc cannot currently be recommended for them. Given the variability in the dose, formulation and duration of zinc use in the included studies, more research is needed to address these before zinc use can be generally recommended for the common cold. However, as the zinc lozenges formulation has been widely studied, and there is a significant reduction in the duration of cold at a dose of ≥ 75 mg/day, for those considering using zinc it would be best to use it at this dose throughout the cold. When using zinc lozenges (not as syrup or tablets) the likely benefit has to be balanced against side effects, notably a bad taste and nausea. Regarding prophylactic zinc supplementation, currently no firm recommendation can be made because of insufficient data.

Authors' conclusions: 

Zinc administered within 24 hours of onset of symptoms reduces the duration of common cold symptoms in healthy people but some caution is needed due to the heterogeneity of the data. As the zinc lozenges formulation has been widely studied and there is a significant reduction in the duration of cold at a dose of ≥ 75 mg/day, for those considering using zinc it would be best to use it at this dose throughout the cold. Regarding prophylactic zinc supplementation, currently no firm recommendation can be made because of insufficient data. When using zinc lozenges (not as syrup or tablets) the likely benefit has to be balanced against side effects, notably a bad taste and nausea.

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Background: 

The common cold is one of the most widespread illnesses and is a leading cause of visits to the doctor and absence from school and work. Trials conducted in high-income countries since 1984 investigating the role of zinc for the common cold symptoms have had mixed results. Inadequate treatment masking and reduced bioavailability of zinc from some formulations have been cited as influencing results.

Objectives: 

To assess whether zinc (irrespective of the zinc salt or formulation used) is efficacious in reducing the incidence, severity and duration of common cold symptoms. In addition, we aimed to identify potential sources of heterogeneity in results obtained and to assess their clinical significance.

Search strategy: 

In this updated review, we searched CENTRAL (2012, Issue 12), MEDLINE (1966 to January week 2, 2013), EMBASE (1974 to January 2013), CINAHL (1981 to January 2013), Web of Science (1985 to January 2013), LILACS (1982 to January 2013), WHO ICTRP and clinicaltrials.gov.

Selection criteria: 

Randomised, double-blind, placebo-controlled trials using zinc for at least five consecutive days to treat, or for at least five months to prevent the common cold.

Data collection and analysis: 

Two review authors independently extracted data and assessed trial quality.

Main results: 

Five trials were identified in the updated searches in January 2013 and two of them did not meet our inclusion criteria. We included 16 therapeutic trials (1387 participants) and two preventive trials (394 participants). Intake of zinc was associated with a significant reduction in the duration (days) (mean difference (MD) -1.03, 95% confidence interval (CI) -1.72 to -0.34) (P = 0.003) (I2 statistic = 89%) but not the severity of common cold symptoms (MD -1.06, 95% CI -2.36 to 0.23) (P = 0.11) (I2 statistic = 84%). The proportion of participants who were symptomatic after seven days of treatment was significantly smaller (odds ratio (OR) 0.45, 95% CI 0.20 to 1.00) (P = 0.05) than those in the control, (Istatistic = 75%). The incidence rate ratio (IRR) of developing a cold (IRR 0.64, 95% CI 0.47 to 0.88) (P = 0.006) (I2 statistic = 88%), school absence (P = 0.0003) and prescription of antibiotics (P < 0.00001) was lower in the zinc group. Overall adverse events (OR 1.58, 95% CI 1.19 to 2.09) (P = 0.002), bad taste (OR 2.31, 95% CI 1.71 to 3.11) (P < 0.00001) and nausea (OR 2.15, 95% CI 1.44 to 3.23) (P = 0.002) were higher in the zinc group. The very high heterogeneity means that the averaged estimates must be viewed with caution.