India · Paediatric Diarrhoea (IAP/WHO) · Zinc Deficiency · Growth Faltering · Adult · Zincolak · Z&D · Zincovit
Zinc reduces diarrhoea duration by ~25% and severity by ~30%. It must always be given alongside ORS, not as a substitute. Use the ORS Calculator to calculate the rehydration dose simultaneously.
Continue zinc for the full 14 days even after diarrhoea stops — this prevents recurrence over the next 2–3 months.
⚠️ Excess zinc (>40mg/day long-term) impairs copper absorption → copper deficiency anaemia
⚠️ Nausea and vomiting are common — give after food
⚠️ Avoid with fluoroquinolones and tetracyclines (separate by 2h)
⚠️ Zinc + iron compete for absorption — space by 1–2 hours
| Indication | Age group | Dose | Duration | Guideline |
|---|---|---|---|---|
| Acute diarrhoea | < 6 months | 10 mg elemental zinc OD | 14 days (continue after diarrhoea stops) | IAP · WHO 2006 |
| Acute diarrhoea | ≥ 6 months to 5 years | 20 mg elemental zinc OD | 14 days | IAP · WHO 2006 |
| Zinc deficiency | Child (any age) | 0.5–1 mg/kg/day (max 40mg) | 2–3 months | BNFC |
| Growth faltering / SAM | Child 6m–5yr | 2 mg/kg/day (max 40mg) | For duration of therapeutic feeding | WHO SAM protocol |
| Adult supplementation | Adult | 10–25 mg elemental/day | Ongoing | RDA India: 10mg ♀, 12mg ♂ |
| Adult deficiency treatment | Adult | 45–50 mg elemental/day | 1–3 months then review | BNF |
| Wound healing | Adult | 45 mg/day elemental | Until healed | BNF |
| Pregnancy supplement | Pregnant / lactating | 11–13 mg/day elemental | Throughout pregnancy | ICMR RDA |
Zinc supplementation for acute diarrhoea in children is one of the most evidence-backed interventions in paediatric medicine. The IAP and WHO 2006 guidelines recommend 10 mg elemental zinc daily for infants under 6 months and 20 mg daily for children aged 6 months to 5 years, for a 14-day course. This recommendation is based on multiple RCTs showing that zinc reduces diarrhoea duration by 25%, diarrhoea severity by 30%, and prevents another diarrhoeal episode in the following 2–3 months by replenishing intestinal zinc stores and restoring gut mucosal integrity. Despite being included in national IMNCI guidelines and government diarrhoea management protocols since 2010, zinc supplementation for diarrhoea remains underutilised in Indian primary care.
The 14-day zinc course is non-negotiable per IAP/WHO guidelines. Stopping at diarrhoea resolution misses the therapeutic benefit because the primary mechanism is replenishment of body zinc stores (intestinal enterocytes, immune cells) rather than direct anti-diarrhoeal action. Children in India are chronically zinc-deficient due to predominantly cereal-based diets with high phytate content, which inhibits zinc absorption. A 14-day course corrects this deficit and provides protection against the next infection episode.
Dispersible zinc tablets (Zincolak DT, Z&D 20) dissolve in a small amount of breast milk, water, or ORS solution and are the most practical form for young children. They should be dissolved in approximately 5 ml of liquid and given by spoon or dropper. Zinc syrups (Zincovit syrup) are an alternative but less concentrated; the volume required for 20 mg zinc may be 10 ml (two teaspoons), which is more difficult for a sick child to take. Some ORS formulations now incorporate zinc (Electral Zinc, Zinclyte ORS) — these are convenient but provide only 5–10 mg zinc per sachet, insufficient as a sole zinc source for therapeutic diarrhoea management.