Hidrasec (Racecadotril) for Diarrhea in Children
Hidrasec should NOT be used as primary therapy for diarrhea in children; instead, oral rehydration solution (ORS) with continued feeding is the evidence-based standard of care. The question appears to confuse Hidrasec (racecadotril) with diphenoxylate—these are different medications, but neither is recommended as first-line treatment for pediatric diarrhea.
Primary Treatment Approach
The cornerstone of managing acute diarrhea in children is oral rehydration therapy using ORS, not antidiarrheal medications. 1, 2
Rehydration Protocol
Assess dehydration severity by evaluating skin turgor, mucous membranes, mental status, pulse, and capillary refill time 3, 4, 2
For mild dehydration (3-5% fluid deficit): Administer 50 mL/kg of ORS over 2-4 hours 3, 4, 2
For moderate dehydration (6-9% fluid deficit): Administer 100 mL/kg of ORS over 2-4 hours 3, 4, 2
For severe dehydration (≥10% fluid deficit): Initiate intravenous isotonic fluids (lactated Ringer's or normal saline) immediately until stabilized, then transition to ORS 3, 4, 2
Ongoing Fluid Replacement
Why Antidiarrheal Medications Are NOT Recommended
The CDC explicitly states that "neither antibiotics nor nonspecific antidiarrheal agents are usually indicated for acute diarrhea" in children. 1
Critical Safety Concerns
Antimotility drugs (including loperamide and diphenoxylate) should NOT be given to children under 18 years of age due to serious adverse effects including ileus, drowsiness, respiratory depression, cardiac complications, and potentially fatal abdominal distention 3, 4, 2
These medications can mask the severity of illness and delay appropriate rehydration therapy 1
Nutritional Management
Continue feeding throughout the diarrheal episode—do not withhold food. 1, 2
Formula-fed infants: Resume full-strength formula immediately after rehydration; lactose-free or lactose-reduced formulas are preferred but not mandatory 1
Older children: Continue age-appropriate diet including starches, cereals, yogurt, fruits, and vegetables; avoid foods high in simple sugars and fats 1
Managing Vomiting
For children with vomiting, administer small volumes of ORS (5-10 mL) every 1-2 minutes using a spoon or syringe, gradually increasing as tolerated. 1, 3
Common pitfall: Allowing a thirsty child to drink large volumes rapidly from a cup or bottle often worsens vomiting 1
Over 90% of vomiting children can be successfully rehydrated orally when ORS is given in small, frequent amounts 1
When Antibiotics ARE Indicated
Consider antibiotics only in specific circumstances: 1
- Dysentery (bloody diarrhea) with high fever
- Watery diarrhea lasting more than 5 days
- Stool cultures or clinical setting indicating a specific treatable pathogen
Key Takeaway
The evidence-based approach to pediatric diarrhea prioritizes rehydration with ORS and continued feeding, not antidiarrheal medications like Hidrasec or diphenoxylate. These medications are contraindicated in children due to safety concerns and lack of benefit on meaningful outcomes (morbidity and mortality). 1, 3, 4, 2