Racecadotril In Acute Diarrhoea

Alimentary Pharmacology & Therapeutics

Systematic review: racecadotril in the treatment of acute diarrhoea in children
´ H. SZAJEWSKA, M. RUSZCZYN SKI, A. CHMIELEWSKA & J. WIECZOREK

The 2nd Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland Correspondence to: Dr H. Szajewska, The 2nd Department of Paediatrics, The Medical University of Warsaw, 01-184 Warsaw,Dzialdowska 1, Poland. E-mail: hania@ipgate.pl

SUMMARY Background Racecadotril (acetorphan) is an antisecretory drug that exerts its antidiarrhoeal effects by inhibiting intestinal enkephalinase. Aim To summarize studies testing the efficacy and safety of racecadotril for treating children with acute gastroenteritis. Methods Reports were gathered by searching electronic databases MEDLINE, EMBASE, theCochrane Library (all up to April 2007), relevant journals, and bibliographies of reviewed articles. Only randomized-controlled trials were included. Results Three randomized-controlled trials (471 participants) met the inclusion criteria. Two trials reported stool output, and data suggested less stool output in the racecadotril group than in the control group. The duration of diarrhoea wassignificantly reduced in the three trials reporting this outcome. Achievement of a cure by day 5 was similar in both groups. Adverse effects were similar in both groups. Conclusions The small number of included trials provided some evidence in favour of the use of racecadotril over placebo or no intervention, to reduce the stool output and duration of diarrhoea in children with acute gastroenteritis.However, more data in out-patients are needed. The safety as well as the cost-effectiveness of the therapy should be explored, before routine therapy with racecadotril is recommended.
Aliment Pharmacol Ther 26, 807–813

Publication data Submitted 20 June 2007 First decision 9 July 2007 Resubmitted 9 July 2007 Accepted 11 July 2007

ª 2007 The Authors Journal compilation ª 2007 Blackwell PublishingLtd doi:10.1111/j.1365-2036.2007.03444.x

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808 H . S Z A J E W S K A et al.

BACKGROUND
Acute gastroenteritis is generally a self-limited illness lasting 5–7 days, and thus the main aim of treatment was to prevent dehydration, metabolic acidosis and electrolyte disturbances. In the vast majority of cases of acute gastroenteritis with mild or moderate dehydration, this can be treatedwith oral rehydration solutions. Despite the proven efficacy of oral rehydration, it remains underused.1 The main reason for this is that an oral rehydration solution neither reduces the frequency of bowel movements and fluid loss nor shortens the duration of illness, which decreases its acceptance and prompts interest in adjunctive treatments. Not only parents and carers, but also doctors demandsafe, effective and inexpensive agents as an additional treatment that will visibly reduce the frequency and fluidity of stools during gastroenteritis. Racecadotril (acetorphan) is an antisecretory drug that exerts its antidiarrhoeal effects by inhibiting intestinal enkephalinase; this prevents the breakdown of endogenous opioids (enkephalins) in the gastrointestinal tract and reduces the secretion ofwater and electrolytes into the gut without interfering with motility.2 Some randomized-controlled trials (RCTs) have proven its efficacy in adults and in children; however, there is no systematic review of the evidence for its efficacy. Thus, this review was undertaken to assess the overall effectiveness of racecadotril in the treatment of acute gastroenteritis in children and to provide someguidance with respect to future research. This review was initiated as part of the development of the guidelines for the management of acute gastroenteritis in children (submitted).

or more loose stools per day, trials in which other definitions of diarrhoea used were also included. The primary outcome measures were stool output and the duration of the diarrhoea. The secondary outcome measures...