From the Guidelines
Racecadotril is not recommended for routine use in children due to its unavailability in North America and limited evidence on its safety and efficacy in this population. When considering the management of acute infectious diarrhea in children, the primary focus should be on oral rehydration therapy, as it is the cornerstone of treatment 180, 181. According to the 2017 Infectious Diseases Society of America clinical practice guidelines, antimotility and antisecretory agents, such as loperamide, can be used to shorten the duration of diarrhea in adults, but their use in children is more cautious due to the risk of adverse events 182. Some key points to consider when managing diarrhea in children include:
- Oral rehydration therapy is essential for all ages
- Antiemetic agents like ondansetron can be beneficial in reducing vomiting, but their use should be weighed against potential side effects 176
- Loperamide can reduce stool volume, but its use is associated with adverse events, particularly in children under 3 years old 182
- Racecadotril, although effective in reducing stool volume, is not available in North America, limiting its use in this population 180, 181. Given the potential risks and limitations associated with antidiarrheal medications, parents should be advised to seek medical attention if their child shows signs of dehydration, bloody stools, persistent fever, or if diarrhea continues beyond 48 hours despite treatment, and to prioritize oral rehydration therapy as the primary treatment approach 1.
From the Research
Use of Racecadotril in Children
The use of Racecadotril (Acetorphan) in children is primarily as an adjunct to oral rehydration therapy for the treatment of acute diarrhea.
- Efficacy: Studies have shown that Racecadotril can reduce the risk of rehydration failure 2, decrease stool output 3, 4, 5, and shorten the duration of diarrhea 4, 6.
- Safety: The drug has been found to be well-tolerated in children, with most adverse events being mild or moderate 2, 3, 4, 6.
- Comparison to Other Treatments: Racecadotril has been compared to placebo and other active treatments, and has been found to be superior in terms of efficacy, with a tolerability profile similar to that of placebo 6.
- Clinical Applications: The use of Racecadotril in children has been studied in various settings, including outpatient and inpatient facilities, and has been found to be effective in reducing the number of stools and shortening the duration of diarrhea 3, 4, 5.
- Recommendations: While current evidence does not support the routine use of Racecadotril in the management of acute diarrhea in children outside of the context of placebo-controlled RCTs 2, other studies suggest that it can be a useful adjunct to oral rehydration therapy in certain cases 3, 4, 5, 6.